1.1.................... moves to amend H.F. No. 1329 as follows:
1.2Delete everything after the enacting clause and insert:

1.3    "Section 1. Minnesota Statutes 2008, section 144A.44, subdivision 2, is amended to
1.4read:
1.5    Subd. 2. Interpretation and enforcement of rights. These rights are established
1.6for the benefit of persons who receive home care services. "Home care services" means
1.7home care services as defined in section 144A.43, subdivision 3, and unlicensed personal
1.8care assistance services, including services covered by medical assistance under section
1.9256B.0625, subdivision 19a. A home care provider may not require a person to surrender
1.10these rights as a condition of receiving services. A guardian or conservator or, when there
1.11is no guardian or conservator, a designated person, may seek to enforce these rights. This
1.12statement of rights does not replace or diminish other rights and liberties that may exist
1.13relative to persons receiving home care services, persons providing home care services, or
1.14providers licensed under Laws 1987, chapter 378. A copy of these rights must be provided
1.15to an individual at the time home care services, including personal care assistance
1.16services, are initiated. The copy shall also contain the address and phone number of the
1.17Office of Health Facility Complaints and the Office of Ombudsman for Long-Term Care
1.18and a brief statement describing how to file a complaint with these offices. Information
1.19about how to contact the Office of Ombudsman for Long-Term Care shall be included in
1.20notices of change in client fees and in notices where home care providers initiate transfer
1.21or discontinuation of services.

1.22    Sec. 2. Minnesota Statutes 2008, section 256B.0625, subdivision 6a, is amended to
1.23read:
1.24    Subd. 6a. Home health services. Home health services are those services specified
1.25in Minnesota Rules, part 9505.0295 sections 256B.0651 and 256B.0653. Medical
1.26assistance covers home health services at a recipient's home residence. Medical assistance
2.1does not cover home health services for residents of a hospital, nursing facility, or
2.2intermediate care facility, unless the commissioner of human services has prior authorized
2.3skilled nurse visits for less than 90 days for a resident at an intermediate care facility for
2.4persons with developmental disabilities, to prevent an admission to a hospital or nursing
2.5facility or unless a resident who is otherwise eligible is on leave from the facility and the
2.6facility either pays for the home health services or forgoes the facility per diem for the
2.7leave days that home health services are used. Home health services must be provided by
2.8a Medicare certified home health agency. All nursing and home health aide services must
2.9be provided according to sections 256B.0651 to 256B.0656 256B.0653.

2.10    Sec. 3. Minnesota Statutes 2008, section 256B.0625, subdivision 7, is amended to read:
2.11    Subd. 7. Private duty nursing. Medical assistance covers private duty nursing
2.12services in a recipient's home. Recipients who are authorized to receive private duty
2.13nursing services in their home may use approved hours outside of the home during hours
2.14when normal life activities take them outside of their home. To use private duty nursing
2.15services at school, the recipient or responsible party must provide written authorization in
2.16the care plan identifying the chosen provider and the daily amount of services to be used at
2.17school. Medical assistance does not cover private duty nursing services for residents of a
2.18hospital, nursing facility, intermediate care facility, or a health care facility licensed by the
2.19commissioner of health, except as authorized in section 256B.64 for ventilator-dependent
2.20recipients in hospitals or unless a resident who is otherwise eligible is on leave from the
2.21facility and the facility either pays for the private duty nursing services or forgoes the
2.22facility per diem for the leave days that private duty nursing services are used. Total hours
2.23of service and payment allowed for services outside the home cannot exceed that which is
2.24otherwise allowed in an in-home setting according to sections 256B.0651 and 256B.0653
2.25256B.0654 to 256B.0656. All private duty nursing services must be provided according to
2.26the limits established under sections 256B.0651 and 256B.0653 to 256B.0656. Private
2.27duty nursing services may not be reimbursed if the nurse is the foster care provider of
2.28a recipient who is under age 18.

2.29    Sec. 4. Minnesota Statutes 2008, section 256B.0625, subdivision 8, is amended to read:
2.30    Subd. 8. Physical therapy. Medical assistance covers physical therapy, as
2.31described in section 148.65, and related services, including specialized maintenance
2.32therapy. Services provided by a physical therapy assistant shall be reimbursed at the
2.33same rate as services performed by a physical therapist when the services of the physical
2.34therapy assistant are provided under the direction of a physical therapist who is on the
2.35premises. Services provided by a physical therapy assistant that are provided under the
3.1direction of a physical therapist who is not on the premises shall be reimbursed at 65
3.2percent of the physical therapist rate.

3.3    Sec. 5. Minnesota Statutes 2008, section 256B.0625, subdivision 8a, is amended to
3.4read:
3.5    Subd. 8a. Occupational therapy. Medical assistance covers occupational therapy,
3.6as described in section 148.6404, and related services, including specialized maintenance
3.7therapy. Services provided by an occupational therapy assistant shall be reimbursed at
3.8the same rate as services performed by an occupational therapist when the services of
3.9the occupational therapy assistant are provided under the direction of the occupational
3.10therapist who is on the premises. Services provided by an occupational therapy assistant
3.11that are provided under the direction of an occupational therapist who is not on the
3.12premises shall be reimbursed at 65 percent of the occupational therapist rate.

3.13    Sec. 6. Minnesota Statutes 2008, section 256B.0625, subdivision 19a, is amended to
3.14read:
3.15    Subd. 19a. Personal care assistant services. Medical assistance covers personal
3.16care assistant services in a recipient's home. To qualify for personal care assistant services,
3.17a recipient must require assistance and be determined dependent in one activity of daily
3.18living as defined in section 256B.0659 or have a level I behavior as defined in section
3.19256B.0659. Recipients or responsible parties must be able to identify the recipient's needs,
3.20direct and evaluate task accomplishment, and provide for health and safety. Approved
3.21hours may be used outside the home when normal life activities take them outside the
3.22home. To use personal care assistant services at school, the recipient or responsible party
3.23must provide written authorization in the care plan identifying the chosen provider and the
3.24daily amount of services to be used at school. Total hours for services, whether actually
3.25performed inside or outside the recipient's home, cannot exceed that which is otherwise
3.26allowed for personal care assistant services in an in-home setting according to sections
3.27256B.0651 and 256B.0653 to 256B.0656. Medical assistance does not cover personal care
3.28assistant services for residents of a hospital, nursing facility, intermediate care facility,
3.29health care facility licensed by the commissioner of health, or unless a resident who is
3.30otherwise eligible is on leave from the facility and the facility either pays for the personal
3.31care assistant services or forgoes the facility per diem for the leave days that personal care
3.32assistant services are used. All personal care assistant services must be provided according
3.33to sections 256B.0651 and 256B.0653 to 256B.0656. Personal care assistant services may
3.34not be reimbursed if the personal care assistant is the spouse or legal paid guardian of the
3.35recipient or the parent of a recipient under age 18, or the responsible party or the foster
4.1care provider of a recipient who cannot direct the recipient's own care unless, in the case of
4.2a foster care provider, a county or state case manager visits the recipient as needed, but not
4.3less than every six months, to monitor the health and safety of the recipient and to ensure
4.4the goals of the care plan are met. Parents of adult recipients, adult children of the recipient
4.5or adult siblings of the recipient may be reimbursed for personal care assistant services,
4.6if they are granted a waiver under sections 256B.0651 and 256B.0653 to 256B.0656.
4.7Notwithstanding the provisions of section 256B.0655, subdivision 2, paragraph (b), clause
4.8(4) 256B.0659, the noncorporate legal unpaid guardian or conservator of an adult, who
4.9is not the responsible party and not the personal care provider organization, may be
4.10granted a hardship waiver under sections 256B.0651 and 256B.0653 to 256B.0656, to be
4.11reimbursed to provide personal care assistant services to the recipient if the guardian or
4.12conservator meet all criteria for a personal care assistant according to section 256B.0659,
4.13and shall not be considered to have a service provider interest for purposes of participation
4.14on the screening team under section 256B.092, subdivision 7.

4.15    Sec. 7. Minnesota Statutes 2008, section 256B.0625, subdivision 19c, is amended to
4.16read:
4.17    Subd. 19c. Personal care. (a) Medical assistance covers personal care assistant
4.18services provided by an individual who is qualified to provide the services according
4.19to subdivision 19a and sections 256B.0651 and 256B.0653 to 256B.0656, where the
4.20services have a statement of need by a physician, provided in accordance with a plan, and
4.21are supervised by the recipient or a qualified professional. The physician's statement of
4.22need for personal care assistant services shall be documented on a form approved by the
4.23commissioner and include the diagnosis or condition of the person that results in a need
4.24for personal care assistant services and be updated when the person's medical condition
4.25requires a change, but at least annually if the need for personal care assistant services is
4.26ongoing.
4.27    (b) "Qualified professional" means a mental health professional as defined in section
4.28245.462, subdivision 18 , or 245.4871, subdivision 27; or a registered nurse as defined in
4.29sections 148.171 to 148.285, or a licensed social worker as defined in section 148B.21; or
4.30qualified developmental disabilities professional under Code of Federal Regulations, title
4.3142. As part of the assessment, the county public health nurse will assist the recipient or
4.32responsible party to identify the most appropriate person to provide supervision of the
4.33personal care assistant. The qualified professional shall perform the duties described
4.34required in Minnesota Rules, part 9505.0335, subpart 4 section 256B.0659.

4.35    Sec. 8. Minnesota Statutes 2008, section 256B.0651, is amended to read:
5.1256B.0651 HOME CARE SERVICES.
5.2    Subdivision 1. Definitions. (a) "Activities of daily living" includes eating, toileting,
5.3grooming, dressing, bathing, transferring, mobility, and positioning For the purposes of
5.4sections 256B.0651 to 256B.0656 and 256B.0659, the terms in paragraphs (b) to (g)
5.5have the meanings given.
5.6(b) "Activities of daily living" has the meaning given in section 256B.0659,
5.7subdivision 1, paragraph (b).
5.8(b) (c) "Assessment" means a review and evaluation of a recipient's need for home
5.9care services conducted in person as required in section 256B.0911. Assessments for home
5.10health agency services shall be conducted by a home health agency nurse. Assessments
5.11for medical assistance home care services for developmental disability and alternative care
5.12services for developmentally disabled home and community-based waivered recipients
5.13may be conducted by the county public health nurse to ensure coordination and avoid
5.14duplication. Assessments must be completed on forms provided by the commissioner
5.15within 30 days of a request for home care services by a recipient or responsible party.
5.16(c) (d) "Home care services" means a health service, determined by the commissioner
5.17as medically necessary, that is ordered by a physician and documented in a service plan
5.18that is reviewed by the physician at least once every 60 days for the provision of home
5.19health services, or private duty nursing, or at least once every 365 days for personal care.
5.20Home care services are provided to the recipient at the recipient's residence that is a
5.21place other than a hospital or long-term care facility or as specified in section 256B.0625
5.22means medical assistance covered services that are home health agency services, including
5.23skilled nurse visits; home health aide visits; physical therapy, occupational therapy,
5.24respiratory therapy, and language-speech pathology therapy; private duty nursing; and
5.25personal care assistance.
5.26(e) "Home residence" means a residence owned or rented by the recipient either
5.27alone, with roommates of the recipient's choosing, or with an unpaid responsible party
5.28or legal representative; or a family foster home where the license holder lives with the
5.29recipient and is not paid to provide home care services for the recipient.
5.30(d) (f) "Medically necessary" has the meaning given in Minnesota Rules, parts
5.319505.0170 to 9505.0475.
5.32(e) "Telehomecare" means the use of telecommunications technology by a home
5.33health care professional to deliver home health care services, within the professional's
5.34scope of practice, to a patient located at a site other than the site where the practitioner
5.35is located.
6.1(g) "Ventilator-dependent" means an individual who receives mechanical ventilation
6.2for life support at least six hours per day and is expected to be or has been dependent on a
6.3ventilator for at least 30 consecutive days.
6.4    Subd. 2. Services covered. Home care services covered under this section and
6.5sections 256B.0653 256B.0652 to 256B.0656 and 256B.0659 include:
6.6(1) nursing services under section sections 256B.0625, subdivision 6a, and
6.7256B.0653 ;
6.8(2) private duty nursing services under section sections 256B.0625, subdivision
6.97 , and 256B.0654;
6.10(3) home health services under section sections 256B.0625, subdivision 6a, and
6.11256B.0653 ;
6.12(4) personal care assistant services under section sections 256B.0625, subdivision
6.1319a , and 256B.0659;
6.14(5) supervision of personal care assistant services provided by a qualified
6.15professional under section sections 256B.0625, subdivision 19a, and 256B.0659;
6.16(6) qualified professional of personal care assistant services under the fiscal
6.17intermediary option as specified in section 256B.0655, subdivision 7;
6.18(7) (6) face-to-face assessments by county public health nurses for services under
6.19section sections 256B.0625, subdivision 19a, and 256B.0659; and
6.20(8) (7) service updates and review of temporary increases for personal care assistant
6.21services by the county public health nurse for services under section sections 256B.0625,
6.22subdivision 19a , and 256B.0659.
6.23    Subd. 3. Noncovered home care services. The following home care services are
6.24not eligible for payment under medical assistance:
6.25(1) skilled nurse visits for the sole purpose of supervision of the home health aide;
6.26(2) a skilled nursing visit:
6.27(i) only for the purpose of monitoring medication compliance with an established
6.28medication program for a recipient; or
6.29(ii) to administer or assist with medication administration, including injections,
6.30prefilling syringes for injections, or oral medication set-up of an adult recipient, when as
6.31determined and documented by the registered nurse, the need can be met by an available
6.32pharmacy or the recipient is physically and mentally able to self-administer or prefill
6.33a medication;
6.34(3) home care services to a recipient who is eligible for covered services under the
6.35Medicare program or any other insurance held by the recipient;
6.36(4) services to other members of the recipient's household;
7.1(5) a visit made by a skilled nurse solely to train other home health agency workers;
7.2(6) any home care service included in the daily rate of the community-based
7.3residential facility where the recipient is residing;
7.4(7) nursing and rehabilitation therapy services that are reasonably accessible to a
7.5recipient outside the recipient's place of residence, excluding the assessment, counseling
7.6and education, and personal assistant care;
7.7(8) any home health agency service, excluding personal care assistant services and
7.8private duty nursing services, which are performed in a place other than the recipient's
7.9residence; and
7.10(9) Medicare evaluation or administrative nursing visits on dual-eligible recipients
7.11that do not qualify for Medicare visit billing.
7.12(1) services provided in a nursing facility, hospital, or intermediate care facility with
7.13exceptions in section 256B.0653;
7.14(2) services for the sole purpose of monitoring medication compliance with an
7.15established medication program for a recipient;
7.16(3) home care services for covered services under the Medicare program or any other
7.17insurance held by the recipient;
7.18(4) services to other members of the recipient's household;
7.19(5) any home care service included in the daily rate of the community-based
7.20residential facility where the recipient is residing;
7.21(6) nursing and rehabilitation therapy services that are reasonably accessible to a
7.22recipient outside the recipient's place of residence, excluding the assessment, counseling
7.23and education, and personal assistance care; or
7.24(7) Medicare evaluation or administrative nursing visits on dual-eligible recipients
7.25that do not qualify for Medicare visit billing.
7.26    Subd. 4. Prior Authorization; exceptions. All home care services above the limits
7.27in subdivision 11 must receive the commissioner's prior authorization before services
7.28begin, except when:
7.29(1) the home care services were required to treat an emergency medical condition
7.30that if not immediately treated could cause a recipient serious physical or mental disability,
7.31continuation of severe pain, or death. The provider must request retroactive authorization
7.32no later than five working days after giving the initial service. The provider must be able
7.33to substantiate the emergency by documentation such as reports, notes, and admission or
7.34discharge histories;
7.35(2) the home care services were provided on or after the date on which the recipient's
7.36eligibility began, but before the date on which the recipient was notified that the case was
8.1opened. Authorization will be considered if the request is submitted by the provider
8.2within 20 working days of the date the recipient was notified that the case was opened;
8.3a recipient's medical assistance eligibility has lapsed, is then retroactively reinstated,
8.4and an authorization for home care services is completed based on the date of a current
8.5assessment, eligibility, and request for authorization;
8.6(3) a third-party payor for home care services has denied or adjusted a payment.
8.7Authorization requests must be submitted by the provider within 20 working days of the
8.8notice of denial or adjustment. A copy of the notice must be included with the request;
8.9(4) the commissioner has determined that a county or state human services agency
8.10has made an error; or
8.11(5) the professional nurse determines an immediate need for up to 40 skilled nursing
8.12or home health aide visits per calendar year and submits a request for authorization within
8.1320 working days of the initial service date, and medical assistance is determined to be
8.14the appropriate payer. if a recipient enrolled in managed care experiences a temporary
8.15disenrollment from a health plan, the commissioner shall accept the current health plan
8.16authorization for personal care assistance services for up to 60 days. The request must
8.17be received within the first 30 days of the disenrollment. If the recipient's re-enrollment
8.18in managed care is after the 60 days and before 90 days, the provider shall request an
8.19additional 30-day extension of the current health plan authorization, for a total limit of
8.2090 days from the time of disenrollment.
8.21    Subd. 5. Retroactive authorization. A request for retroactive authorization will be
8.22evaluated according to the same criteria applied to prior authorization requests.
8.23    Subd. 6. Prior Authorization. (a) The commissioner, or the commissioner's
8.24designee, shall review the assessment, service update, request for temporary services,
8.25request for flexible use option, service plan, and any additional information that is
8.26submitted. The commissioner shall, within 30 days after receiving a complete request,
8.27assessment, and service plan, authorize home care services as follows: provided in this
8.28section.
8.29(a) Home health services. (b) All Home health services provided by a home health
8.30aide including skilled nurse visits and home health aide visits must be prior authorized
8.31by the commissioner or the commissioner's designee. Prior Authorization must be based
8.32on medical necessity and cost-effectiveness when compared with other care options.
8.33The commissioner must receive the request for authorization of skilled nurse visits and
8.34home health aide visits within 20 working days of the start of service. When home health
8.35services are used in combination with personal care and private duty nursing, the cost of
8.36all home care services shall be considered for cost-effectiveness. The commissioner shall
9.1limit home health aide visits to no more than one visit each per day. The commissioner, or
9.2the commissioner's designee, may authorize up to two skilled nurse visits per day.
9.3(b) Ventilator-dependent recipients. (c) If the recipient is ventilator-dependent, the
9.4monthly medical assistance authorization for home care services shall not exceed what the
9.5commissioner would pay for care at the highest cost hospital designated as a long-term
9.6hospital under the Medicare program. For purposes of this paragraph, home care services
9.7means all direct care services provided in the home that would be included in the payment
9.8for care at the long-term hospital. "Ventilator-dependent" means an individual who
9.9receives mechanical ventilation for life support at least six hours per day and is expected
9.10to be or has been dependent for at least 30 consecutive days. Recipients who meet the
9.11definition of ventilator dependent and the EN home care rating and utilize a combination
9.12of home care services are limited up to a total of 24 hours of home care services per day.
9.13Additional hours may be authorized when a recipient's assessment indicates a need for two
9.14staff to perform activities. Additional time is limited to four hours per day.
9.15    Subd. 7. Prior Authorization; time limits. (a) The commissioner or the
9.16commissioner's designee shall determine the time period for which a prior an authorization
9.17shall be effective and, if flexible use has been requested, whether to allow the flexible use
9.18option. If the recipient continues to require home care services beyond the duration of
9.19the prior authorization, the home care provider must request a new prior authorization.
9.20A personal care provider agency must request a new personal care assistant services
9.21assessment, or service update if allowed, at least 60 days prior to the end of the current
9.22prior authorization time period. The request for the assessment must be made on a form
9.23approved by the commissioner. Under no circumstances, other than the exceptions
9.24in subdivision 4, shall a prior An authorization must be valid prior to the date the
9.25commissioner receives the request or for no more than 12 months.
9.26(b) A recipient who appeals a reduction in previously authorized home care
9.27services may continue previously authorized services, other than temporary services
9.28under subdivision 8, pending an appeal under section 256.045. The commissioner must
9.29provide a detailed explanation of why the authorized services are reduced in amount from
9.30those requested by the home care provider.
9.31    Subd. 8. Prior Authorization requests; temporary services. The agency nurse,
9.32the independently enrolled private duty nurse, or county public health nurse may request
9.33a temporary authorization for home care services by telephone. The commissioner may
9.34approve a temporary level of home care services based on the assessment, and service
9.35or care plan information, and primary payer coverage determination information as
9.36required. Authorization for a temporary level of home care services including nurse
10.1supervision is limited to the time specified by the commissioner, but shall not exceed
10.245 days, unless extended because the county public health nurse has not completed the
10.3required assessment and service plan, or the commissioner's determination has not been
10.4made. The level of services authorized under this provision shall have no bearing on a
10.5future prior authorization.
10.6    Subd. 9. Prior Authorization for foster care setting. (a) Home care services
10.7provided in an adult or child foster care setting must receive prior authorization by the
10.8department commissioner according to the limits established in subdivision 11.
10.9(b) The commissioner may not authorize:
10.10(1) home care services that are the responsibility of the foster care provider under
10.11the terms of the foster care placement agreement and administrative rules;
10.12(2) personal care assistant services when the foster care license holder is also
10.13the personal care provider or personal care assistant unless the recipient can direct the
10.14recipient's own care, or case management is provided as required in section 256B.0625,
10.15subdivision 19a ; or
10.16(3) personal care assistant services when the responsible party is an employee of, or
10.17under contract with, or has any direct or indirect financial relationship with the personal
10.18care provider or personal care assistant, unless case management is provided as required
10.19in section 256B.0625, subdivision 19a; or
10.20(4) (3) personal care assistant and private duty nursing services when the number
10.21of foster care residents licensed capacity is greater than four unless the county responsible
10.22for the recipient's foster placement made the placement prior to April 1, 1992, requests
10.23that personal care assistant and private duty nursing services be provided, and case
10.24management is provided as required in section 256B.0625, subdivision 19a.
10.25    Subd. 10. Limitation on payments. Medical assistance payments for home care
10.26services shall be limited according to subdivisions 4 to 12 and sections 256B.0654,
10.27subdivision 2 , and 256B.0655, subdivisions 3 and 4.
10.28    Subd. 11. Limits on services without prior authorization. A recipient may receive
10.29the following home care services during a calendar year:
10.30(1) up to two face-to-face assessments to determine a recipient's need for personal
10.31care assistant services;
10.32(2) one service update done to determine a recipient's need for personal care assistant
10.33services; and
10.34(3) up to nine face-to-face skilled nurse visits.
10.35    Subd. 12. Approval of home care services. The commissioner or the
10.36commissioner's designee shall determine the medical necessity of home care services, the
11.1level of caregiver according to subdivision 2, and the institutional comparison according to
11.2subdivisions 4 to 12 and sections 256B.0654, subdivision 2, and 256B.0655, subdivisions
11.33 and 4 256B.0659, the cost-effectiveness of services, and the amount, scope, and duration
11.4of home care services reimbursable by medical assistance, based on the assessment,
11.5primary payer coverage determination information as required, the service plan, the
11.6recipient's age, the cost of services, the recipient's medical condition, and diagnosis or
11.7disability. The commissioner may publish additional criteria for determining medical
11.8necessity according to section 256B.04.
11.9    Subd. 13. Recovery of excessive payments. The commissioner shall seek
11.10monetary recovery from providers of payments made for services which exceed the limits
11.11established in this section and sections 256B.0653 to 256B.0656 and 256B.0659. This
11.12subdivision does not apply to services provided to a recipient at the previously authorized
11.13level pending an appeal under section 256.045, subdivision 10.
11.14    Subd. 14. Referrals to Medicare providers required. Home care providers that
11.15do not participate in or accept Medicare assignment must refer and document the referral
11.16of dual-eligible recipients to Medicare providers when Medicare is determined to be the
11.17appropriate payer for services and supplies and equipment. Providers must be terminated
11.18from participation in the medical assistance program for failure to make these referrals.
11.19    Subd. 15. Quality assurance for program integrity. The commissioner shall
11.20maintain processes for monitoring ongoing program integrity including provider standards
11.21and training, consumer surveys, and random reviews of documentation.
11.22    Subd. 16. Oversight of enrolled providers. The commissioner shall establish
11.23an ongoing quality assurance process for home care services. The commissioner has
11.24the authority to request proof of documentation of meeting provider standards, quality
11.25standards of care, correct billing practices, and other information. Failure to provide access
11.26and information to demonstrate compliance with laws, rules, or policies must result in
11.27suspension, denial, or termination of the provider agency's enrollment with the department.

11.28    Sec. 9. Minnesota Statutes 2008, section 256B.0652, is amended to read:
11.29256B.0652 PRIOR AUTHORIZATION AND REVIEW OF HOME CARE
11.30SERVICES.
11.31    Subdivision 1. State coordination. The commissioner shall supervise the
11.32coordination of the prior authorization and review of home care services that are
11.33reimbursed by medical assistance.
12.1    Subd. 2. Duties. (a) The commissioner may contract with or employ qualified
12.2registered nurses and necessary support staff, or contract with qualified agencies, to
12.3provide home care prior authorization and review services for medical assistance
12.4recipients who are receiving home care services.
12.5(b) Reimbursement for the prior authorization function shall be made through the
12.6medical assistance administrative authority. The state shall pay the nonfederal share.
12.7The functions will be to:
12.8(1) assess the recipient's individual need for services required to be cared for safely
12.9in the community;
12.10(2) ensure that a service care plan that meets the recipient's needs is developed
12.11by the appropriate agency or individual;
12.12(3) ensure cost-effectiveness and nonduplication of medical assistance home care
12.13services;
12.14(4) recommend the approval or denial of the use of medical assistance funds to pay
12.15for home care services;
12.16(5) reassess the recipient's need for and level of home care services at a frequency
12.17determined by the commissioner; and
12.18(6) conduct on-site assessments when determined necessary by the commissioner
12.19and recommend changes to care plans that will provide more efficient and appropriate
12.20home care.; and
12.21(7) on the department's Web site:
12.22(i) provide a link to MinnesotaHelp.info for a list of enrolled home care agencies
12.23with the following information: main office address, contact information for the agency,
12.24counties in which services are provided, type of home care services provided, whether
12.25the personal care assistance choice option is offered, types of qualified professionals
12.26employed, number of personal care assistants employed, and data on staff turnover; and
12.27(ii) post data on home care services including information from both fee-for-service
12.28and managed care plans on recipients as available.
12.29(c) In addition, the commissioner or the commissioner's designee may:
12.30(1) review care service plans and reimbursement data for utilization of services that
12.31exceed community-based standards for home care, inappropriate home care services,
12.32medical necessity, home care services that do not meet quality of care standards, or
12.33unauthorized services and make appropriate referrals within the department or to other
12.34appropriate entities based on the findings;
12.35(2) assist the recipient in obtaining services necessary to allow the recipient to
12.36remain safely in or return to the community;
13.1(3) coordinate home care services with other medical assistance services under
13.2section 256B.0625;
13.3(4) assist the recipient with problems related to the provision of home care services;
13.4(5) assure the quality of home care services; and
13.5(6) assure that all liable third-party payers including, but not limited to, Medicare
13.6have been used prior to medical assistance for home care services, including but not
13.7limited to, home health agency, elected hospice benefit, waivered services, alternative care
13.8program services, and personal care services.
13.9(d) For the purposes of this section, "home care services" means medical assistance
13.10services defined under section 256B.0625, subdivisions 6a, 7, and 19a.
13.11    Subd. 3. Assessment and prior authorization process for persons receiving
13.12personal care assistance and developmental disabilities services. Effective January 1,
13.131996, For purposes of providing informed choice, coordinating of local planning decisions,
13.14and streamlining administrative requirements, the assessment and prior authorization
13.15process for persons receiving both home care and home and community-based waivered
13.16services for persons with developmental disabilities shall meet the requirements of
13.17sections 256B.0651 and 256B.0653 to 256B.0656 with the following exceptions:
13.18(a) Upon request for home care services and subsequent assessment by the public
13.19health nurse under sections 256B.0651 and 256B.0653 to 256B.0656, the public health
13.20nurse shall participate in the screening process, as appropriate, and, if home care
13.21services are determined to be necessary, participate in the development of a service plan
13.22coordinating the need for home care and home and community-based waivered services
13.23with the assigned county case manager, the recipient of services, and the recipient's legal
13.24representative, if any.
13.25(b) The public health nurse shall give prior authorization for home care services
13.26to the extent that home care services are:
13.27(1) medically necessary;
13.28(2) chosen by the recipient and their legal representative, if any, from the array of
13.29home care and home and community-based waivered services available;
13.30(3) coordinated with other services to be received by the recipient as described
13.31in the service plan; and
13.32(4) provided within the county's reimbursement limits for home care and home and
13.33community-based waivered services for persons with developmental disabilities.
13.34(c) If the public health agency is or may be the provider of home care services to the
13.35recipient, the public health agency shall provide the commissioner of human services with
14.1a written plan that specifies how the assessment and prior authorization process will be
14.2held separate and distinct from the provision of services.

14.3    Sec. 10. Minnesota Statutes 2008, section 256B.0653, is amended to read:
14.4256B.0653 HOME HEALTH AGENCY COVERED SERVICES.
14.5    Subdivision 1. Homecare; skilled nurse visits Scope. "Skilled nurse visits" are
14.6provided in a recipient's residence under a plan of care or service plan that specifies a level
14.7of care which the nurse is qualified to provide. These services are:
14.8(1) nursing services according to the written plan of care or service plan and accepted
14.9standards of medical and nursing practice in accordance with chapter 148;
14.10(2) services which due to the recipient's medical condition may only be safely and
14.11effectively provided by a registered nurse or a licensed practical nurse;
14.12(3) assessments performed only by a registered nurse; and
14.13(4) teaching and training the recipient, the recipient's family, or other caregivers
14.14requiring the skills of a registered nurse or licensed practical nurse. This section applies to
14.15home health agency services including, home health aide, skilled nursing visits, physical
14.16therapy, occupational therapy, respiratory therapy, and speech language pathology therapy.
14.17    Subd. 2. Telehomecare; skilled nurse visits Definitions. Medical assistance
14.18covers skilled nurse visits according to section 256B.0625, subdivision 6a, provided via
14.19telehomecare, for services which do not require hands-on care between the home care
14.20nurse and recipient. The provision of telehomecare must be made via live, two-way
14.21interactive audiovisual technology and may be augmented by utilizing store-and-forward
14.22technologies. Store-and-forward technology includes telehomecare services that do not
14.23occur in real time via synchronous transmissions, and that do not require a face-to-face
14.24encounter with the recipient for all or any part of any such telehomecare visit. Individually
14.25identifiable patient data obtained through real-time or store-and-forward technology must
14.26be maintained as health records according to sections 144.291 to 144.298. If the video
14.27is used for research, training, or other purposes unrelated to the care of the patient, the
14.28identity of the patient must be concealed. A communication between the home care nurse
14.29and recipient that consists solely of a telephone conversation, facsimile, electronic mail, or
14.30a consultation between two health care practitioners, is not to be considered a telehomecare
14.31visit. Multiple daily skilled nurse visits provided via telehomecare are allowed. Coverage
14.32of telehomecare is limited to two visits per day. All skilled nurse visits provided via
14.33telehomecare must be prior authorized by the commissioner or the commissioner's
14.34designee and will be covered at the same allowable rate as skilled nurse visits provided
14.35in-person. For the purposes of this section, the following terms have the meanings given.
15.1(a) "Assessment" means an evaluation of the recipient's medical need for home
15.2health agency services by a registered nurse or appropriate therapist that is conducted
15.3within 30 days of a request and as specified in Code of Federal Regulations, title 42,
15.4sections 484.1 to 494.55.
15.5(b) "Home care therapies" means occupational, physical, and respiratory therapy
15.6and speech-language pathology services, provided in the home by a Medicare-certified
15.7home health agency.
15.8(c) "Home health agency services" means services delivered in the recipient's home
15.9residence, except as specified in section 256B.0625, by a home health agency to a recipient
15.10with medical needs due to illness, disability, or physical conditions.
15.11(d) "Home health aide" means an employee of a home health agency who meets
15.12the requirements of Code of Federal Regulations, title 42, sections 484.1 to 494.55, and
15.13completes medically oriented tasks written in the plan of care for a recipient.
15.14(e) "Home health agency" means a home care provider agency that is
15.15Medicare-certified satisfying the requirements of Code of Federal Regulations, title 42,
15.16sections 484.1 to 494.55.
15.17(f) "Occupational therapy services" mean the services defined in section 148.6402.
15.18(g) "Physical therapy services" mean the services defined in section 148.65.
15.19(h) "Respiratory therapy services" mean the services defined in chapter 147C and
15.20Minnesota Rules, part 4668.0003, subpart 37.
15.21(i) "Speech-language pathology services" mean the services defined in section
15.22148.512.
15.23(j) "Skilled nurse visit" means a professional nursing visit to complete nursing tasks
15.24required due to a recipient's medical condition that can only be safely provided by a
15.25professional nurse to restore and maintain optimal health.
15.26(k) "Store-and-forward technology" means telehomecare services that do not occur
15.27in real time via synchronous transmissions such as diabetic and vital sign monitoring.
15.28(l) "Telehomecare" means the use of telecommunications technology via
15.29live, two-way interactive audiovisual technology which may be augmented by
15.30store-and-forward technology.
15.31(m) "Telehomecare skilled nurse visit" means a visit by a professional nurse to
15.32deliver a skilled nurse visit to a recipient located at a site other than the site where the
15.33nurse is located and is used in combination with face-to-face skilled nurse visits to
15.34adequately meet the recipient's needs.
15.35    Subd. 3. Therapies through home health agencies Home health aide visits.
15.36(a) Medical assistance covers physical therapy and related services, including specialized
16.1maintenance therapy. Services provided by a physical therapy assistant shall be
16.2reimbursed at the same rate as services performed by a physical therapist when the
16.3services of the physical therapy assistant are provided under the direction of a physical
16.4therapist who is on the premises. Services provided by a physical therapy assistant that are
16.5provided under the direction of a physical therapist who is not on the premises shall be
16.6reimbursed at 65 percent of the physical therapist rate. Direction of the physical therapy
16.7assistant must be provided by the physical therapist as described in Minnesota Rules, part
16.89505.0390, subpart 1, item B. The physical therapist and physical therapist assistant may
16.9not both bill for services provided to a recipient on the same day.
16.10(b) Medical assistance covers occupational therapy and related services, including
16.11specialized maintenance therapy. Services provided by an occupational therapy assistant
16.12shall be reimbursed at the same rate as services performed by an occupational therapist
16.13when the services of the occupational therapy assistant are provided under the direction of
16.14the occupational therapist who is on the premises. Services provided by an occupational
16.15therapy assistant under the direction of an occupational therapist who is not on the
16.16premises shall be reimbursed at 65 percent of the occupational therapist rate. Direction
16.17of the occupational therapy assistant must be provided by the occupational therapist as
16.18described in Minnesota Rules, part 9505.0390, subpart 1, item B. The occupational
16.19therapist and occupational therapist assistant may not both bill for services provided
16.20to a recipient on the same day.
16.21(a) Home health aide visits must be provided by a certified home health aide
16.22using a written plan of care that is updated in compliance with Medicare regulations.
16.23A home health aide shall provide hands-on personal care, perform simple procedures
16.24as an extension of therapy or nursing services, and assist in instrumental activities of
16.25daily living as defined in section 256B.0659. Home health aide visits must be provided
16.26in the recipient's home.
16.27(b) All home health aide visits must have authorization under section 256B.0652.
16.28The commissioner shall limit home health aide visits to no more than one visit per day
16.29per recipient.
16.30(c) Home health aides must be supervised by a registered nurse or an appropriate
16.31therapist when providing services that are an extension of therapy.
16.32    Subd. 4. Skilled nurse visit services. (a) Skilled nurse visit services must be
16.33provided by a registered nurse or a licensed practical nurse under the supervision of a
16.34registered nurse, according to the written plan of care and accepted standards of medical
16.35and nursing practice according to chapter 148. Skilled nurse visit services must be ordered
16.36by a physician and documented in a plan of care that is reviewed and approved by the
17.1ordering physician at least once every 60 days. All skilled nurse visits must be medically
17.2necessary and provided in the recipient's home residence except as allowed under section
17.3256B.0625, subdivision 6a.
17.4(b) Skilled nurse visits include face-to-face and telehomecare visits with a limit of
17.5up to two visits per day per recipient. All visits must be based on assessed needs.
17.6(c) Telehomecare skilled nurse visits are allowed when the recipient's health status
17.7can be accurately measured and assessed without a need for a face-to-face, hands-on
17.8encounter. All telehomecare skilled nurse visits must have authorization and are paid at
17.9the same allowable rates as face-to-face skilled nurse visits.
17.10(d) The provision of telehomecare must be made via live, two-way interactive
17.11audiovisual technology and may be augmented by utilizing store-and-forward
17.12technologies. Individually identifiable patient data obtained through real-time or
17.13store-and-forward technology must be maintained as health records according to sections
17.14144.291 to 144.298. If the video is used for research, training, or other purposes unrelated
17.15to the care of the patient, the identity of the patient must be concealed.
17.16(e) Authorization for skilled nurse visits must be completed under section
17.17256B.0652. A total of nine face-to-face skilled nurses visits per calendar year do not
17.18require authorization. All telehomecare skilled nurse visits require authorization.
17.19    Subd. 5. Home care therapies. (a) Home care therapies include the following:
17.20physical therapy, occupational therapy, respiratory therapy, and speech and language
17.21pathology therapy services.
17.22(b) Home care therapies must be:
17.23(1) provided in the recipient's residence after it has been determined the recipient is
17.24unable to access outpatient therapy;
17.25(2) prescribed, ordered, or referred by a physician and documented in a plan of care
17.26and reviewed, according to Minnesota Rules, part 9505.0390;
17.27(3) assessed by an appropriate therapist; and
17.28(4) provided by a Medicare-certified home health agency enrolled as a Medicaid
17.29provider agency.
17.30(c) Restorative and specialized maintenance therapies must be provided according to
17.31Minnesota Rules, part 9505.0390. Physical and occupational therapy assistants may be
17.32used as allowed under Minnesota Rules, part 9505.0390, subpart 1, item B.
17.33(d) For both physical and occupational therapies, the therapist and the therapist's
17.34assistant may not both bill for services provided to a recipient on the same day.
17.35    Subd. 6. Noncovered home health agency services. The following are not eligible
17.36for payment under medical assistance as a home health agency service:
18.1(1) telehomecare skilled nurses services that is communication between the home
18.2care nurse and recipient that consists solely of a telephone conversation, facsimile,
18.3electronic mail, or a consultation between two health care practitioners;
18.4(2) the following skilled nurse visits:
18.5(i) for the purpose of monitoring medication compliance with an established
18.6medication program for a recipient;
18.7(ii) administering or assisting with medication administration, including injections,
18.8prefilling syringes for injections, or oral medication setup of an adult recipient, when,
18.9as determined and documented by the registered nurse, the need can be met by an
18.10available pharmacy or the recipient or a family member is physically and mentally able
18.11to self-administer or prefill a medication;
18.12(iii) services done for the sole purpose of supervision of the home health aide or
18.13personal care assistant;
18.14(iv) services done for the sole purpose to train other home health agency workers;
18.15(v) services done for the sole purpose of blood samples or lab draw or Synagis
18.16injections when the recipient is able to access these services outside the home; and
18.17(vi) Medicare evaluation or administrative nursing visits required by Medicare;
18.18(3) home health aide visits when the following activities are the sole purpose for the
18.19visit: companionship, socialization, household tasks, transportation, and education; and
18.20(4) home care therapies provided in other settings such as a clinic, day program, or as
18.21an inpatient or when the recipient can access therapy outside of the recipient's residence.

18.22    Sec. 11. Minnesota Statutes 2008, section 256B.0654, is amended to read:
18.23256B.0654 PRIVATE DUTY NURSING.
18.24    Subdivision 1. Definitions. (a) "Assessment" means a review and evaluation of a
18.25recipient's need for home care services conducted in person. Assessments for private duty
18.26nursing shall be conducted by a registered private duty nurse. Assessments for medical
18.27assistance home care services for developmental disabilities and alternative care services
18.28for developmentally disabled home and community-based waivered recipients may be
18.29conducted by the county public health nurse to ensure coordination and avoid duplication.
18.30(b) (a) "Complex and regular private duty nursing care" means:
18.31(1) complex care is private duty nursing services provided to recipients who are
18.32ventilator dependent or for whom a physician has certified that were it not for private
18.33duty nursing the recipient would meet meets the criteria for inpatient hospital intensive
18.34care unit (ICU) level of care; and
18.35(2) regular care is private duty nursing provided to all other recipients.
19.1(b) "Private duty nursing" means ongoing professional nursing services by a
19.2registered or licensed practical nurse including assessment, professional nursing tasks, and
19.3education, based on an assessment and physician orders to maintain or restore optimal
19.4health of the recipient.
19.5(c) "Private duty nursing agency" means a medical assistance enrolled provider
19.6licensed under chapter 144A to provide private duty nursing services.
19.7(d) "Regular private duty nursing" means nursing services provided to a recipient
19.8who is considered stable and not at an inpatient hospital intensive care unit level of care,
19.9but may have episodes of instability that are not life threatening.
19.10(e) "Shared private duty nursing" means the provision of nursing services by a
19.11private duty nurse to two recipients at the same time and in the same setting.
19.12    Subd. 2. Authorization; private duty nursing services. (a) All private duty
19.13nursing services shall be prior authorized by the commissioner or the commissioner's
19.14designee. Prior Authorization for private duty nursing services shall be based on
19.15medical necessity and cost-effectiveness when compared with alternative care options.
19.16The commissioner may authorize medically necessary private duty nursing services in
19.17quarter-hour units when:
19.18(1) the recipient requires more individual and continuous care than can be provided
19.19during a skilled nurse visit; or
19.20(2) the cares are outside of the scope of services that can be provided by a home
19.21health aide or personal care assistant.
19.22(b) The commissioner may authorize:
19.23(1) up to two times the average amount of direct care hours provided in nursing
19.24facilities statewide for case mix classification "K" as established by the annual cost report
19.25submitted to the department by nursing facilities in May 1992;
19.26(2) private duty nursing in combination with other home care services up to the total
19.27cost allowed under section 256B.0655, subdivision 4;
19.28(3) up to 16 hours per day if the recipient requires more nursing than the maximum
19.29number of direct care hours as established in clause (1) and the recipient meets the hospital
19.30admission criteria established under Minnesota Rules, parts 9505.0501 to 9505.0540.
19.31(c) The commissioner may authorize up to 16 hours per day of medically necessary
19.32private duty nursing services or up to 24 hours per day of medically necessary private duty
19.33nursing services until such time as the commissioner is able to make a determination of
19.34eligibility for recipients who are cooperatively applying for home care services under
19.35the community alternative care program developed under section 256B.49, or until it is
19.36determined by the appropriate regulatory agency that a health benefit plan is or is not
20.1required to pay for appropriate medically necessary health care services. Recipients
20.2or their representatives must cooperatively assist the commissioner in obtaining this
20.3determination. Recipients who are eligible for the community alternative care program
20.4may not receive more hours of nursing under this section and sections 256B.0651,
20.5256B.0653 , 256B.0655, and 256B.0656, and 256B.0659 than would otherwise be
20.6authorized under section 256B.49.
20.7    Subd. 2a. Private duty nursing services. (a) Private duty nursing services must
20.8be used:
20.9(1) in the recipient's home or outside the home when normal life activities require;
20.10(2) when the recipient requires more individual and continuous care than can be
20.11provided during a skilled nurse visit; and
20.12(3) when the care required is outside of the scope of services that can be provided by
20.13a home health aide or personal care assistant.
20.14(b) Private duty nursing services must be:
20.15(1) assessed by a registered nurse on a form approved by the commissioner;
20.16(2) ordered by a physician and documented in a plan of care that is reviewed by the
20.17physician at least once every 60 days; and
20.18(3) authorized by the commissioner under section 256B.0652.
20.19    Subd. 2b. Noncovered private duty nursing services. Private duty nursing
20.20services do not cover the following:
20.21(1) nursing services by a nurse who is the foster care provider of a person who has
20.22not reached 18 years of age unless allowed under subdivision 4;
20.23(2) nursing services to more than two persons receiving shared private duty nursing
20.24services from a private duty nurse in a single setting; and
20.25(3) nursing services provided by a registered nurse or licensed practical nurse who is
20.26the recipient's legal guardian or related to the recipient as spouse, parent, or child, whether
20.27by blood, marriage, or adoption except as specified in section 256B.0652, subdivision 4.
20.28    Subd. 3. Shared private duty nursing care option. (a) Medical assistance
20.29payments for shared private duty nursing services by a private duty nurse shall be limited
20.30according to this subdivision. For the purposes of this section and sections 256B.0651,
20.31256B.0653, 256B.0655, and 256B.0656, "private duty nursing agency" means an agency
20.32licensed under chapter 144A to provide private duty nursing services. Unless otherwise
20.33provided in this subdivision, all other statutory and regulatory provisions relating to
20.34private duty nursing services apply to shared private duty nursing services. Nothing in
20.35this subdivision shall be construed to reduce the total number of private duty nursing
20.36hours authorized for an individual recipient.
21.1(b) Recipients of private duty nursing services may share nursing staff and the
21.2commissioner shall provide a rate methodology for shared private duty nursing. For two
21.3persons sharing nursing care, the rate paid to a provider shall not exceed 1.5 times the
21.4regular private duty nursing rates paid for serving a single individual by a registered nurse
21.5or licensed practical nurse. These rates apply only to situations in which both recipients
21.6are present and receive shared private duty nursing care on the date for which the service
21.7is billed. No more than two persons may receive shared private duty nursing services
21.8from a private duty nurse in a single setting.
21.9(c) (b) Shared private duty nursing care is the provision of nursing services by a
21.10private duty nurse to two medical assistance eligible recipients at the same time and in
21.11the same setting. This subdivision does not apply when a private duty nurse is caring for
21.12multiple recipients in more than one setting.
21.13(c) For the purposes of this subdivision, "setting" means:
21.14(1) the home residence or foster care home of one of the individual recipients as
21.15defined in section 256B.0651; or
21.16(2) a child care program licensed under chapter 245A or operated by a local school
21.17district or private school; or
21.18(3) an adult day care service licensed under chapter 245A; or
21.19(4) outside the home residence or foster care home of one of the recipients when
21.20normal life activities take the recipients outside the home.
21.21This subdivision does not apply when a private duty nurse is caring for multiple
21.22recipients in more than one setting.
21.23(d) The private duty nursing agency must offer the recipient the option of shared or
21.24one-on-one private duty nursing services. The recipient may withdraw from participating
21.25in a shared service arrangement at any time.
21.26(d) (e) The recipient or the recipient's legal representative, and the recipient's
21.27physician, in conjunction with the home health care private duty nursing agency, shall
21.28determine:
21.29(1) whether shared private duty nursing care is an appropriate option based on the
21.30individual needs and preferences of the recipient; and
21.31(2) the amount of shared private duty nursing services authorized as part of the
21.32overall authorization of nursing services.
21.33(e) (f) The recipient or the recipient's legal representative, in conjunction with the
21.34private duty nursing agency, shall approve the setting, grouping, and arrangement of
21.35shared private duty nursing care based on the individual needs and preferences of the
22.1recipients. Decisions on the selection of recipients to share services must be based on the
22.2ages of the recipients, compatibility, and coordination of their care needs.
22.3(f) (g) The following items must be considered by the recipient or the recipient's
22.4legal representative and the private duty nursing agency, and documented in the recipient's
22.5health service record:
22.6(1) the additional training needed by the private duty nurse to provide care to
22.7two recipients in the same setting and to ensure that the needs of the recipients are met
22.8appropriately and safely;
22.9(2) the setting in which the shared private duty nursing care will be provided;
22.10(3) the ongoing monitoring and evaluation of the effectiveness and appropriateness
22.11of the service and process used to make changes in service or setting;
22.12(4) a contingency plan which accounts for absence of the recipient in a shared private
22.13duty nursing setting due to illness or other circumstances;
22.14(5) staffing backup contingencies in the event of employee illness or absence; and
22.15(6) arrangements for additional assistance to respond to urgent or emergency care
22.16needs of the recipients.
22.17(g) The provider must offer the recipient or responsible party the option of shared or
22.18one-on-one private duty nursing services. The recipient or responsible party can withdraw
22.19from participating in a shared service arrangement at any time.
22.20(h) The private duty nursing agency must document the following in the
22.21health service record for each individual recipient sharing private duty nursing care
22.22The documentation for shared private duty nursing must be on a form approved by
22.23the commissioner for each individual recipient sharing private duty nursing. The
22.24documentation must be part of the recipient's health service record and include:
22.25(1) permission by the recipient or the recipient's legal representative for the
22.26maximum number of shared nursing care hours per week chosen by the recipient and
22.27permission for shared private duty nursing services provided in and outside the recipient's
22.28home residence;
22.29(2) permission by the recipient or the recipient's legal representative for shared
22.30private duty nursing services provided outside the recipient's residence;
22.31(3) permission by the recipient or the recipient's legal representative for others to
22.32receive shared private duty nursing services in the recipient's residence;
22.33(4) (2) revocation by the recipient or the recipient's legal representative of for the
22.34shared private duty nursing care authorization, or the shared care to be provided to others in
22.35the recipient's residence, or the shared private duty nursing services to be provided outside
22.36permission, or services provided to others in and outside the recipient's residence; and
23.1(5) (3) daily documentation of the shared private duty nursing services provided by
23.2each identified private duty nurse, including:
23.3(i) the names of each recipient receiving shared private duty nursing services
23.4together;
23.5(ii) the setting for the shared services, including the starting and ending times that
23.6the recipient received shared private duty nursing care; and
23.7(iii) notes by the private duty nurse regarding changes in the recipient's condition,
23.8problems that may arise from the sharing of private duty nursing services, and scheduling
23.9and care issues.
23.10(i) Unless otherwise provided in this subdivision, all other statutory and regulatory
23.11provisions relating to private duty nursing services apply to shared private duty nursing
23.12services.
23.13Nothing in this subdivision shall be construed to reduce the total number of private
23.14duty nursing hours authorized for an individual recipient under subdivision 2.
23.15(i) The commissioner shall provide a rate methodology for shared private duty
23.16nursing. For two persons sharing nursing care, the rate paid to a provider must not exceed
23.171.5 times the regular private duty nursing rates paid for serving a single individual by a
23.18registered nurse or licensed practical nurse. These rates apply only to situations in which
23.19both recipients are present and receive shared private duty nursing care on the date for
23.20which the service is billed.
23.21    Subd. 4. Hardship criteria; private duty nursing. (a) Payment is allowed for
23.22extraordinary services that require specialized nursing skills and are provided by parents
23.23of minor children, family foster parents, spouses, and legal guardians who are providing
23.24private duty nursing care under the following conditions:
23.25(1) the provision of these services is not legally required of the parents, family
23.26foster parents, spouses, or legal guardians;
23.27(2) the services are necessary to prevent hospitalization of the recipient; and
23.28(3) the recipient is eligible for state plan home care or a home and community-based
23.29waiver and one of the following hardship criteria are met:
23.30(i) the parent, spouse, or legal guardian resigns from a part-time or full-time job to
23.31provide nursing care for the recipient; or
23.32(ii) the parent, spouse, or legal guardian goes from a full-time to a part-time job with
23.33less compensation to provide nursing care for the recipient; or
23.34(iii) the parent, spouse, or legal guardian takes a leave of absence without pay to
23.35provide nursing care for the recipient; or
24.1(iv) because of labor conditions, special language needs, or intermittent hours of
24.2care needed, the parent, spouse, or legal guardian is needed in order to provide adequate
24.3private duty nursing services to meet the medical needs of the recipient.
24.4(b) Private duty nursing may be provided by a parent, spouse, or legal guardian who
24.5is a nurse licensed in Minnesota. Private duty nursing services provided by a parent,
24.6spouse, or legal guardian cannot be used in lieu of nursing services covered and available
24.7under liable third-party payors, including Medicare. The private duty nursing provided by
24.8a parent, family foster parent, spouse, or legal guardian must be included in the service
24.9plan. Authorized skilled nursing services for a single recipient or recipients with the same
24.10residence and provided by the parent, family foster parent, spouse, or legal guardian
24.11may not exceed 50 percent of the total approved nursing hours, or eight hours per day,
24.12whichever is less, up to a maximum of 40 hours per week. A parent or parents, family
24.13foster parents, spouse, or legal guardian shall not provide more than 40 hours of services in
24.14a seven-day period. For parents, family foster parents, and legal guardians, 40 hours is the
24.15total amount allowed regardless of the number of children or adults who receive services.
24.16Nothing in this subdivision precludes the parent's, family foster parents', spouse's, or legal
24.17guardian's obligation of assuming the nonreimbursed family responsibilities of emergency
24.18backup caregiver and primary caregiver.
24.19(c) A parent, family foster parent, or a spouse may not be paid to provide private
24.20duty nursing care if:
24.21(1) the parent or spouse fails to pass a criminal background check according to
24.22chapter 245C, or if;
24.23(2) it has been determined by the home health care agency, the case manager, or the
24.24physician that the private duty nursing care provided by the parent, family foster parents,
24.25spouse, or legal guardian is unsafe; or
24.26(3) the parent, family foster parents, spouse, or legal guardian do not follow
24.27physician orders.
24.28(d) For purposes of this section, "assessment" means a review and evaluation of a
24.29recipient's need for home care services conducted in person. Assessments for private duty
24.30nursing must be conducted by a registered nurse.

24.31    Sec. 12. Minnesota Statutes 2008, section 256B.0655, subdivision 1b, is amended to
24.32read:
24.33    Subd. 1b. Assessment. "Assessment" means a review and evaluation of a recipient's
24.34need for home care services conducted in person. Assessments for personal care assistant
24.35services shall be conducted by the county public health nurse or a certified public
25.1health nurse under contract with the county. A face-to-face An in-person assessment
25.2must include: documentation of health status, determination of need, evaluation of
25.3service effectiveness, identification of appropriate services, service plan development
25.4or modification, coordination of services, referrals and follow-up to appropriate payers
25.5and community resources, completion of required reports, recommendation of service
25.6authorization, and consumer education. Once the need for personal care assistant
25.7services is determined under this section or sections 256B.0651, 256B.0653, 256B.0654,
25.8and 256B.0656, the county public health nurse or certified public health nurse under
25.9contract with the county is responsible for communicating this recommendation to the
25.10commissioner and the recipient. A face-to-face assessment for personal care assistant
25.11services is conducted on those recipients who have never had a county public health
25.12nurse assessment. A face-to-face An in-person assessment must occur at least annually or
25.13when there is a significant change in the recipient's condition or when there is a change
25.14in the need for personal care assistant services. A service update may substitute for
25.15the annual face-to-face assessment when there is not a significant change in recipient
25.16condition or a change in the need for personal care assistant service. A service update
25.17may be completed by telephone, used when there is no need for an increase in personal
25.18care assistant services, and used for two consecutive assessments if followed by a
25.19face-to-face assessment. A service update must be completed on a form approved by the
25.20commissioner. A service update or review for temporary increase includes a review of
25.21initial baseline data, evaluation of service effectiveness, redetermination of service need,
25.22modification of service plan and appropriate referrals, update of initial forms, obtaining
25.23service authorization, and on going consumer education. Assessments must be completed
25.24on forms provided by the commissioner within 30 days of a request for home care services
25.25by a recipient or responsible party or personal care provider agency.

25.26    Sec. 13. Minnesota Statutes 2008, section 256B.0655, subdivision 4, is amended to
25.27read:
25.28    Subd. 4. Prior Authorization; personal care assistance and qualified
25.29professional. The commissioner, or the commissioner's designee, shall review the
25.30assessment, service update, request for temporary services, request for flexible use option,
25.31service plan, and any additional information that is submitted. The commissioner shall,
25.32within 30 days after receiving a complete request, assessment, and service plan, authorize
25.33home care services as follows:
25.34(1) (a) All personal care assistant services and, supervision by a qualified
25.35professional, if requested by the recipient, and additional services beyond the limits
26.1established in section 256B.0652, subdivision 11, must be prior authorized by the
26.2commissioner or the commissioner's designee before services begin except for the
26.3assessments established in section sections 256B.0651, subdivision 11, and 256B.0911.
26.4The authorization for personal care assistance and qualified professional services under
26.5section 256B.0659 must be completed within 30 calendar days after receiving a complete
26.6request.
26.7(b) The amount of personal care assistant services authorized must be based on
26.8the recipient's home care rating. The home care rating shall be determined by the
26.9commissioner or the commissioner's designee based on information submitted to the
26.10commissioner identifying the following:
26.11A child may not be found to be dependent in an activity of daily living if because
26.12of the child's age an adult would either perform the activity for the child or assist the
26.13child with the activity and the amount of assistance needed is similar to the assistance
26.14appropriate for a typical child of the same age. Based on medical necessity, the
26.15commissioner may authorize:
26.16(A) up to two times the average number of direct care hours provided in nursing
26.17facilities for the recipient's comparable case mix level; or
26.18(B) up to three times the average number of direct care hours provided in nursing
26.19facilities for recipients who have complex medical needs or are dependent in at least seven
26.20activities of daily living and need physical assistance with eating or have a neurological
26.21diagnosis; or
26.22(C) up to 60 percent of the average reimbursement rate, as of July 1, 1991, for care
26.23provided in a regional treatment center for recipients who have Level I behavior, plus any
26.24inflation adjustment as provided by the legislature for personal care service; or
26.25(D) up to the amount the commissioner would pay, as of July 1, 1991, plus any
26.26inflation adjustment provided for home care services, for care provided in a regional
26.27treatment center for recipients referred to the commissioner by a regional treatment center
26.28preadmission evaluation team. For purposes of this clause, home care services means
26.29all services provided in the home or community that would be included in the payment
26.30to a regional treatment center; or
26.31(E) up to the amount medical assistance would reimburse for facility care for
26.32recipients referred to the commissioner by a preadmission screening team established
26.33under section 256B.0911 or 256B.092; and
26.34(F) a reasonable amount of time for the provision of supervision by a qualified
26.35professional of personal care assistant services, if a qualified professional is requested by
26.36the recipient or responsible party.
27.1(2) The number of direct care hours shall be determined according to the annual cost
27.2report submitted to the department by nursing facilities. The average number of direct care
27.3hours, as established by May 1, 1992, shall be calculated and incorporated into the home
27.4care limits on July 1, 1992. These limits shall be calculated to the nearest quarter hour.
27.5(3) The home care rating shall be determined by the commissioner or the
27.6commissioner's designee based on information submitted to the commissioner by the
27.7county public health nurse on forms specified by the commissioner. The home care rating
27.8shall be a combination of current assessment tools developed under sections 256B.0911
27.9and 256B.501 with an addition for seizure activity that will assess the frequency and
27.10severity of seizure activity and with adjustments, additions, and clarifications that are
27.11necessary to reflect the needs and conditions of recipients who need home care including
27.12children and adults under 65 years of age. The commissioner shall establish these forms
27.13and protocols under this section and sections 256B.0651, 256B.0653, 256B.0654, and
27.14256B.0656 and shall use an advisory group, including representatives of recipients,
27.15providers, and counties, for consultation in establishing and revising the forms and
27.16protocols.
27.17(4) A recipient shall qualify as having complex medical needs if the care required is
27.18difficult to perform and because of recipient's medical condition requires more time than
27.19community-based standards allow or requires more skill than would ordinarily be required
27.20and the recipient needs or has one or more of the following:
27.21(A) daily tube feedings;
27.22(B) daily parenteral therapy;
27.23(C) wound or decubiti care;
27.24(D) postural drainage, percussion, nebulizer treatments, suctioning, tracheotomy
27.25care, oxygen, mechanical ventilation;
27.26(E) catheterization;
27.27(F) ostomy care;
27.28(G) quadriplegia; or
27.29(H) other comparable medical conditions or treatments the commissioner determines
27.30would otherwise require institutional care.
27.31(5) A recipient shall qualify as having Level I behavior if there is reasonable
27.32supporting evidence that the recipient exhibits, or that without supervision, observation, or
27.33redirection would exhibit, one or more of the following behaviors that cause, or have the
27.34potential to cause:
27.35(A) injury to the recipient's own body;
27.36(B) physical injury to other people; or
28.1(C) destruction of property.
28.2(6) Time authorized for personal care relating to Level I behavior in paragraph
28.3(5), clauses (A) to (C), shall be based on the predictability, frequency, and amount of
28.4intervention required.
28.5(7) A recipient shall qualify as having Level II behavior if the recipient exhibits on a
28.6daily basis one or more of the following behaviors that interfere with the completion of
28.7personal care assistant services under subdivision 2, paragraph (a):
28.8(A) unusual or repetitive habits;
28.9(B) withdrawn behavior; or
28.10(C) offensive behavior.
28.11(8) A recipient with a home care rating of Level II behavior in paragraph (7), clauses
28.12(A) to (C), shall be rated as comparable to a recipient with complex medical needs under
28.13paragraph (4). If a recipient has both complex medical needs and Level II behavior, the
28.14home care rating shall be the next complex category up to the maximum rating under
28.15paragraph (1), clause (B).
28.16(1) total number of dependencies of activities of daily living as defined in section
28.17256B.0659;
28.18(2) number of complex health-related functions as defined in section 256B.0659; and
28.19(3) number of behavior descriptions as defined in section 256B.0659.
28.20(c) The methodology to determine total time for personal care assistance services is
28.21based on the median paid units per day for each home care rating from fiscal year 2007
28.22data. Each home care rating has a base level of hours assigned. Additional time is added
28.23through the assessment and identification of the following:
28.24(1) 30 additional minutes per day for a dependency in each critical activity of daily
28.25living as defined in section 256B.0659;
28.26(2) 30 additional minutes per day for each complex health-related function as
28.27defined in section 256B.0659; and
28.28(3) 30 additional minutes per day for each behavior issue as defined in section
28.29256B.0659.
28.30(d) A limit of 96 units of qualified professional supervision may be authorized for
28.31each recipient receiving personal care assistance services. A request to the commissioner
28.32to exceed this total in a calendar year must be requested by the personal care provider
28.33agency on a form approved by the commissioner.

28.34    Sec. 14. [256B.0659] PERSONAL CARE ASSISTANCE PROGRAM.
29.1    Subdivision 1. Definitions. (a) For the purposes of this section, the terms defined in
29.2paragraphs (b) to (p) have the meanings given unless otherwise provided in text.
29.3(b) "Activities of daily living" means grooming, dressing, bathing, transferring,
29.4mobility, positioning, eating, and toileting.
29.5(c) "Behavior" means categories to determine the home care rating and is based on
29.6the criteria found in this section.
29.7(d) "Complex health-related functions" means a category to determine the home care
29.8rating and is based on the criteria found in this section.
29.9(e) "Critical activities of daily living" means transferring, mobility, eating, and
29.10toileting.
29.11(f) "Dependency in activities of daily living" means a person requires assistance to
29.12begin or complete one or more of the activities of daily living.
29.13(g) "Health-related functions" means functions that can be delegated or assigned
29.14by a licensed health care professional under state law to be performed by a personal
29.15care assistant.
29.16(h) "Instrumental activities of daily living" means activities to include meal planning
29.17and preparation; basic assistance with paying bills; shopping for food, clothing, and
29.18other essential items; performing household tasks integral to the personal care assistance
29.19services; communication by telephone and other media; and traveling and participating
29.20in the community.
29.21(i) "Managerial official" has the same definition as described in Code of Federal
29.22Regulations, title 42, section 455.
29.23(j) "Qualified professional" means a professional providing supervision of personal
29.24care assistance services and staff as defined in section 256B.0625, subdivision 19c.
29.25(k) "Personal care assistance provider agency" means a medical assistance enrolled
29.26provider that provides or assists with providing personal care assistance services and
29.27includes personal care assistance provider organizations, personal care assistance choice
29.28agency, class A licensed nursing agency, and Medicare-certified home health agency.
29.29(l) "Personal care assistant" means an individual employed by a personal care
29.30assistance agency that provides personal care assistance services.
29.31(m) "Personal care assistance care plan" means a written description of personal
29.32care assistance services developed by the personal care assistance provider according
29.33to the service plan.
29.34(n) "Responsible party" means an individual who is capable of providing the support
29.35necessary to assist the recipient to live in the community.
30.1(o) "Self-administered medication" means medication taken orally, by injection or
30.2insertion, or applied topically without the need for assistance.
30.3(p) "Service plan" means a written summary of the assessment and description of the
30.4services needed by the recipient.
30.5    Subd. 2. Personal care assistance services; covered services. (a) The personal
30.6care assistance services eligible for payment include services and supports furnished
30.7to an individual, as needed, to assist in:
30.8(1) activities of daily living;
30.9(2) health-related procedures and tasks;
30.10(3) assistance with behavior needs; and
30.11(4) instrumental activities of daily living.
30.12(b) Activities of daily living include the following covered services:
30.13(1) dressing, including assistance with choosing, application, and changing of
30.14clothing and application of special appliances, wraps, or clothing;
30.15(2) grooming, including assistance with basic hair care, oral care, shaving, applying
30.16cosmetics and deodorant, and care of eyeglasses and hearing aids. Nail care is included,
30.17except for recipients who are diabetic or have poor circulation;
30.18(3) bathing, including assistance with basic personal hygiene and skin care;
30.19(4) eating, including assistance with hand washing and application of orthotics
30.20required for eating, transfers, and feeding;
30.21(5) transfers, including assistance with transferring the recipient from one seating or
30.22reclining area to another;
30.23(6) mobility, including assistance with ambulation, including use of a wheelchair.
30.24Mobility does not include providing transportation for a recipient;
30.25(7) positioning, including assistance with positioning or turning a recipient for
30.26necessary care and comfort; and
30.27(8) toileting, including assistance with helping recipient with bowel or bladder
30.28elimination and care including transfers, mobility, positioning, feminine hygiene, use of
30.29toileting equipment or supplies, cleansing the perineal area, inspection of the skin, and
30.30adjusting clothing.
30.31(c) Health-related procedures or tasks include the following covered services:
30.32(1) range of motion and passive exercise to maintain a recipient's optimal level of
30.33strength and muscle functioning;
30.34(2) assistance with self-administered medication as defined by this section, including
30.35reminders to take medication, bringing medication to the recipient, and assistance with
30.36opening medication under the direction of the recipient or responsible party;
31.1(3) interventions for seizure disorders, including monitoring and observation; and
31.2(4) other activities considered within the scope of the personal care service and
31.3meeting the definition of health-related procedures or tasks under this section.
31.4(d) A personal care assistant may perform health-related procedures and tasks
31.5associated with the complex health-related needs of a recipient if the tasks meet the
31.6definition of health-related procedures and tasks under this section and the personal care
31.7assistant is trained by a qualified professional and demonstrates competency to safely
31.8complete the task. Delegation of health-related procedures and tasks and all training must
31.9be documented in the personal care assistance care plan and the recipient's and personal
31.10care assistant's files.
31.11(e) For a personal care assistant to provide the health-related procedures and tasks of
31.12tracheostomy suctioning and services to recipients on ventilator support there must be:
31.13(1) delegation and training by a registered nurse, certified or licensed respiratory
31.14therapist, or a physician;
31.15(2) utilization of clean rather than sterile procedure;
31.16(3) specialized training about the health-related functions and equipment, including
31.17ventilator operation and maintenance;
31.18(4) individualized training regarding the needs of the recipient; and
31.19(5) supervision by a qualified professional who is a registered nurse.
31.20(f) A personal care assistant may observe and redirect the recipient for episodes
31.21where there is a need for redirection due to behaviors. Training of the personal care
31.22assistant must occur based on the needs of the recipient, the personal care assistance care
31.23plan, and any other support services provided.
31.24(g) Instrumental activities of daily living under subdivision 1, paragraph (h), include
31.25accompanying a recipient to obtain medical diagnosis or treatment when assistance is
31.26required by the recipient during the appointment.
31.27    Subd. 3. Noncovered personal care assistance services. (a) Personal care
31.28assistance services are not eligible for medical assistance payment under this section
31.29when provided:
31.30(1) by the recipient's spouse, parent of a recipient under the age of 18, paid legal
31.31guardian, licensed foster provider, or responsible party;
31.32(2) in lieu of other staffing options in a residential or child care setting;
31.33(3) solely as a child care or babysitting service; or
31.34(4) without authorization by the commissioner or the commissioner's designee.
31.35(b) The following personal care services are not eligible for medical assistance
31.36payment under this section when provided in residential settings:
32.1(1) when the provider of home care services who is not related by blood, marriage,
32.2or adoption owns or otherwise controls the living arrangement, including licensed or
32.3unlicensed services; or
32.4(2) when personal care assistance services are the responsibility of a residential or
32.5program license holder under the terms of a service agreement and administrative rules.
32.6(c) Other specific tasks not covered under paragraph (a) or (b) that are not eligible
32.7for medical assistance reimbursement for personal care assistance services under this
32.8section include:
32.9(1) sterile procedures;
32.10(2) injections of fluids and medications into veins, muscles, or skin;
32.11(3) instrumental activities of daily living without a dependency in at least two
32.12activities of daily living;
32.13(4) home maintenance or chore services;
32.14(5) homemaker services not an integral part of assessed personal care assistance
32.15services needed by a recipient;
32.16(6) application of restraints or implementation of procedures under section 245.825;
32.17(7) instrumental activities of daily living for children under the age of 18; and
32.18(8) assessments for personal care assistance services by personal care assistance
32.19provider agencies or by independently enrolled registered nurses.
32.20    Subd. 4. Assessment for personal care assistance services. (a) An assessment as
32.21defined in section 256B.0911 must be completed for personal care assistance services.
32.22(b) The following conditions apply to the assessment:
32.23(1) a person must be assessed as dependent in an activity of daily living based
32.24on the person's need, on a daily basis, for:
32.25(i) cueing or supervision to complete the task; or
32.26(ii) hands-on assistance to complete the task;
32.27(2) an adult may not be found to be dependent in an activity of daily living because
32.28of individual choices; and
32.29(3) a child may not be found to be dependent in an activity of daily living if because
32.30of the child's age an adult would either perform the activity for the child or assist the child
32.31with the activity. Assistance needed is the assistance appropriate for a typical child of
32.32the same age.
32.33(c) Assessment for complex health-related functions must meet the criteria in
32.34this paragraph. During the assessment process, a recipient qualifies as having complex
32.35health-related functions if the recipient has one or more of the interventions that are
33.1ordered by a physician, specified in a personal care assistance care plan, and found in
33.2the following:
33.3(1) tube feedings requiring:
33.4(i) a gastro/jejunostomy tube; or
33.5(ii) continuous tube feeding lasting longer than 12 hours per day;
33.6(2) wounds described as:
33.7    (i) stage III or stage IV;
33.8    (ii) multiple wounds;
33.9    (iii) requiring sterile or clean dressing changes or a wound vac; or
33.10    (iv) open lesions such as burns, fistulas, tube sites, or ostomy sites that require
33.11specialized care;
33.12    (3) parenteral therapy described as:
33.13    (i) IV therapy more than two times per week lasting longer than four hours for
33.14each treatment; or
33.15    (ii) total parenteral nutrition (TPN) daily;
33.16    (4) respiratory interventions including:
33.17    (i) oxygen required more than eight hours per day;
33.18    (ii) respiratory vest more than one time per day;
33.19    (iii) bronchial drainage treatments more than two times per day;
33.20    (iv) sterile or clean suctioning more than six times per day;
33.21    (v) dependence on another to apply respiratory ventilation augmentation devises
33.22such as BiPAP and CPAP; and
33.23    (vi) ventilator dependence under section 256B.0652;
33.24    (5) insertion and maintenance of catheter including:
33.25(i) sterile catheter changes more than one time per month;
33.26(ii) clean self-catheterization more than six times per day; or
33.27(iii) bladder irrigations;
33.28(6) bowel program more than two times per week requiring more than 30 minutes to
33.29perform each time;
33.30(7) neurological intervention including:
33.31(i) seizures more than two times per week and requiring significant physical
33.32assistance to maintain safety; or
33.33(ii) swallowing disorders diagnosed by a physician and requiring specialized
33.34assistance from another on a daily basis; and
33.35(8) other congenital or acquired diseases creating a need for significantly increased
33.36direct hands-on assistance and interventions in six to eight activities of daily living.
34.1(d) An assessment of behaviors must meet the criteria in this paragraph. A recipient
34.2qualifies as having a need for assistance due to behaviors if the recipient's behavior requires
34.3assistance at least four times per week and shows one or more of the following behaviors:
34.4(1) physical aggression towards self, others, or property that requires immediate
34.5response of another;
34.6(2) increased vulnerability due to cognitive deficits or socially inappropriate
34.7behavior; or
34.8(3) verbally aggressive and resistive to care.
34.9    Subd. 5. Service and support planning. (a) The assessor, with the recipient or
34.10responsible party, shall review the assessment information and determine referrals for
34.11other payers, services, and community supports as appropriate.
34.12(b) The recipient must be referred for evaluation, services, or supports that are
34.13appropriate to help meet the recipient's needs including, but not limited to, the following
34.14circumstances:
34.15(1) when there is another payer who is responsible to provide the service to meet
34.16the recipient's needs;
34.17(2) when the recipient qualifies for assistance with behaviors under this section,
34.18a referral into the mental health system for a mental health diagnostic and functional
34.19assessment must be completed;
34.20(3) when the recipient is eligible for medical assistance and meets medical assistance
34.21eligibility for a home health aide or skilled nurse visit;
34.22(4) when the recipient would benefit from an evaluation for another service; and
34.23(5) when there is a more appropriate service to meet the assessed needs.
34.24    (c) The reimbursement rates for public health nurse visits that relate to the provision
34.25of personal care assistance services under this section and section 256B.0625, subdivision
34.2619a , are:
34.27    (1) $210.50 for a face-to-face assessment visit;
34.28    (2) $105.25 for each service update; and
34.29    (3) $105.25 for each request for a temporary service increase.
34.30    (d) The rates specified in paragraph (c) must be adjusted to reflect provider rate
34.31increases for personal care assistance services that are approved by the legislature for the
34.32fiscal year ending June 30, 2000, and subsequent fiscal years. Any requirements applied
34.33by the legislature to provider rate increases for personal care assistance services also
34.34apply to adjustments under this paragraph.
34.35    (e) Effective July 1, 2008, the payment rate for an assessment under this section and
34.36section 256B.0651 shall be reduced by 25 percent when the assessment is not completed
35.1on time and the service agreement documentation is not submitted in time to continue
35.2services. The commissioner shall reduce the amount of the claim for those assessments
35.3that are not submitted on time.
35.4    Subd. 6. Service plan. The service plan must be completed by the assessor with the
35.5recipient and responsible party on a form determined by the commissioner and include
35.6a summary of the assessment with a description of the need, authorized amount, and
35.7expected outcomes and goals of personal care assistance services. The recipient and
35.8the provider chosen by the recipient or responsible party must be given a copy of the
35.9completed service plan. The recipient or responsible party must be given information by
35.10the assessor about the options in the personal care assistance program to allow for review
35.11and decision making.
35.12    Subd. 7. Personal care assistance care plan. (a) Each recipient must have a current
35.13personal care assistance care plan based on the service plan in subdivision 21 that is
35.14developed by the qualified professional with the recipient and responsible party. A copy of
35.15the most current personal care assistance care plan is required to be in the recipient's home
35.16and in the recipient's file at the provider agency.
35.17(b) The personal care assistance care plan must have the following components:
35.18(1) start and end date of the care plan;
35.19(2) recipient demographic information, including name and telephone number;
35.20(3) emergency numbers and procedures, including a backup plan;
35.21(4) name of responsible party and instructions for contact;
35.22(5) description of the recipient's individualized needs for assistance with activities of
35.23daily living, instrumental activities of daily living, health-related tasks, and behaviors; and
35.24(6) dated signatures of recipient or responsible party and qualified professional.
35.25(c) The personal care assistance care plan must have instructions and comments
35.26about the recipient's needs for assistance and any special instructions or procedures
35.27required. The month-to-month plan for the use of personal care assistance services is part
35.28of the personal care assistance care plan. The personal care assistance care plan must
35.29be completed within the first week after start of services with a personal care provider
35.30agency and must be updated as needed when there is a change in need for personal care
35.31assistance services. A new personal care assistance care plan is required annually at the
35.32time of the reassessment.
35.33    Subd. 8. Communication with recipient's physician. The personal care assistance
35.34program requires communication with the recipient's physician about a recipient's assessed
35.35needs for personal care assistance services. The commissioner shall work with the state
35.36medical director to develop options for communication with the recipient's physician.
36.1    Subd. 9. Responsible party; generally. (a) "Responsible party" means an
36.2individual who is capable of providing the support necessary to assist the recipient to live
36.3in the community.
36.4(b) A responsible party must be 18 years of age, actively participate in planning and
36.5directing of personal care assistance services, and attend all assessments for the recipient.
36.6(c) A responsible party must not have a direct or indirect financial interest in care
36.7provided to the recipient and must not be the:
36.8(1) personal care assistant;
36.9(2) home care provider agency staff; or
36.10(3) county staff acting as part of employment.
36.11(d) A licensed family foster parent who lives with the recipient may be the
36.12responsible party as long as the foster parent does not also have a direct or indirect
36.13financial interest in the provision of personal care assistance services.
36.14(e) A responsible party is required when:
36.15(1) the person is a minor according to section 524.5-102, subdivision 10;
36.16(2) the person is an incapacitated adult according to section 524.5-102, subdivision
36.176, resulting in a court-appointed guardian; or
36.18(3) the assessment according to section 256B.0911 determines that the recipient is in
36.19need of a responsible party to direct the recipient's care.
36.20(f) There may be two persons designated as the responsible party for reasons such
36.21as divided households and court-ordered custodies. Each person named as responsible
36.22party must meet the program criteria and responsibilities.
36.23(g) The recipient or the recipient's legal representative shall appoint a responsible
36.24party if necessary to direct and supervise the care provided to the recipient. The
36.25responsible party must be identified at the time of assessment and listed on the recipient's
36.26service agreement and personal care assistance care plan.
36.27    Subd. 10. Responsible party; duties; delegation. (a) A responsible party with a
36.28personal care assistance provider agency shall enter into a written agreement, on a form
36.29determined by the commissioner, to perform the following duties:
36.30(1) be available while care is provided in a method agreed upon by the individual
36.31or the individual's legal representative and documented in the recipient's personal care
36.32assistance care plan;
36.33(2) monitor personal care assistance services to ensure the recipient's personal care
36.34assistance care plan is being followed; and
36.35(3) review and sign personal care assistance time sheets after services are provided
36.36to provide verification that personal care assistance services were provided.
37.1Failure to provide the support required by the recipient must result in a referral to the
37.2county common entry point.
37.3(b) Responsible parties who are parents of minors or guardians of minors or
37.4incapacitated persons may delegate the responsibility to another adult who is not the
37.5personal care assistant during a temporary absence of at least 24 hours but not more
37.6than six months. The person delegated as a responsible party must be able to meet the
37.7definition of the responsible party, except that the delegated responsible party is required
37.8to reside with the recipient only while serving as the responsible party. The responsible
37.9party must ensure that the delegate performs the functions of the responsible party, is
37.10identified at the time of the assessment, and is listed on the personal care assistance
37.11care plan. The responsible party must communicate to the personal care assistance
37.12provider agency about the need for a delegate responsible party, including the name of the
37.13delegated responsible party, dates the delegated responsible party will be acting as the
37.14responsible party, and contact numbers.
37.15    Subd. 11. Personal care assistant; requirements. (a) A personal care assistant
37.16must meet the following requirements:
37.17(1) be at least 18 years of age and if 16 or 17 years of age only if:
37.18(i) supervised by a qualified professional every 60 days; and
37.19(ii) employed by only one personal care assistance provider agency responsible
37.20for compliance with current labor laws;
37.21(2) be employed by a personal care assistance provider agency;
37.22(3) enroll with the department as a non-pay-to provider after clearing a background
37.23study. Before a personal care assistant provides services, the personal care assistance
37.24provider agency must initiate a background study on the personal care assistant under
37.25chapter 245C, and the personal care assistance provider agency must have received a
37.26notice from the commissioner that the personal care assistant is:
37.27(i) not disqualified under section 245C.14; or
37.28(ii) is disqualified, but the personal care assistant has received a set aside of the
37.29disqualification under section 245C.22;
37.30(4) be able to effectively communicate with the recipient and personal care
37.31assistance provider agency;
37.32(5) be able to provide covered personal care assistance services according to the
37.33recipient's personal care assistance care plan, respond appropriately to recipient needs,
37.34and report changes in the recipient's condition to the supervising qualified professional
37.35or physician;
37.36(6) not be a consumer of personal care assistance services;
38.1(7) maintain daily written records including, but not limited to, time sheets under
38.2subdivision 12;
38.3(8) complete standardized training as determined or approved by the commissioner
38.4before completing enrollment. Personal care assistant training must include successful
38.5completion of the following training components: basic first aid, vulnerable adult, child
38.6maltreatment, OSHA universal precautions, basic roles and responsibilities of personal
38.7care assistants including information about assistance with lifting and transfers for
38.8recipients, orientation to positive behavior practices, emergency preparedness, fraud
38.9issues, and completion of time sheets. Included with the basic training is a need for the
38.10personal care assistant to demonstrate competency of ability to understand and provide
38.11assistance. Personal care assistant training and orientation must be completed within the
38.12first seven days after the services begin and be directed to the needs of the recipient and
38.13the recipient's personal care assistance care plan; and
38.14(9) be limited to providing and being paid for no more than 310 hours per month of
38.15personal care assistance services that is determined by the commissioner regardless of
38.16the number of recipients being served or the number of personal care assistance provider
38.17agencies enrolled with.
38.18(b) A legal guardian may be a personal care assistant if the guardian is not being paid
38.19for the guardian services and meets the criteria for personal care assistants in paragraph (a).
38.20(c) Persons who do not qualify as a personal care assistant include parents and
38.21stepparents of minors, spouses, paid legal guardians, foster care providers, except as
38.22otherwise allowed in section 256B.0625, or staff of a residential setting.
38.23    Subd. 12. Documentation of personal care assistance services provided. (a)
38.24Personal care assistance services for a recipient must be documented daily, on a form
38.25approved by the commissioner by each personal care assistant, and kept in the recipient's
38.26home for the current month of service. The completed form must be submitted on a
38.27monthly basis to the provider and kept in the recipient's health record.
38.28(b) The activity documentation must correspond to the personal care assistance care
38.29plan and be reviewed by the qualified professional.
38.30(c) The personal care assistant time sheet must be on a form approved by the
38.31commissioner documenting time the personal care assistant provides services in the home.
38.32The following criteria must be included in the time sheet:
38.33(1) full name of personal care assistant and individual provider number;
38.34(2) provider name and telephone numbers;
38.35(3) full name of recipient;
39.1(4) consecutive dates, including month, day, and year, and arrival and departure
39.2time with a.m. or p.m. notations;
39.3(5) signatures of recipient or the responsible party;
39.4(6) personal signature of the personal care assistant;
39.5(7) any shared care provided, if applicable;
39.6(8) a statement that it is a federal crime to provide false information on personal
39.7care service billings for medical assistance payments; and
39.8(9) dates and location of recipient stays in a hospital, care facility, or incarceration.
39.9    Subd. 13. Qualified professional; qualifications. (a) The qualified professional
39.10must be employed by a personal care assistance provider agency and meet the definition
39.11under section 256B.0625, subdivision 19c. Before a qualified professional provides
39.12services, the personal care assistance provider agency must initiate a background study on
39.13the qualified professional under chapter 245C, and the personal care assistance provider
39.14agency must have received a notice from the commissioner that the qualified professional:
39.15(1) is not disqualified under section 245C.14; or
39.16(2) is disqualified, but the qualified professional has received a set aside of the
39.17disqualification under section 245C.22.
39.18(b) The qualified professional shall perform the duties of training, supervision, and
39.19evaluation of the personal care assistance staff and evaluation of the effectiveness of
39.20personal care assistance services. The qualified professional shall:
39.21(1) develop and monitor with the recipient a personal care assistance care plan based
39.22on the service plan and individualized needs of the recipient;
39.23(2) develop and monitor with the recipient a monthly plan for the use of personal
39.24care assistance services;
39.25(3) review documentation of personal care assistance services provided;
39.26(4) provide training and ensure competency for the personal care assistant in the
39.27individual needs of the recipient; and
39.28(5) document all training, communication, evaluations, and needed actions to
39.29improve performance of the personal care assistants.
39.30(c) The qualified professional shall complete the provider training with basic
39.31information about the personal care assistance program approved by the commissioner
39.32within six months of the date hired by a personal care assistance provider agency.
39.33Qualified professionals who have completed the required trainings as an employee with a
39.34personal care assistance provider agency do not need to repeat the required trainings if they
39.35are hired by another agency, if they have completed the training within the last three years.
40.1    Subd. 14. Qualified professional; duties. (a) All personal care assistants must
40.2be supervised by a qualified professional or in a joint supervision relationship with the
40.3recipient or the responsible party.
40.4(b) Through direct training, observation, return demonstrations, and consultation
40.5with the staff and the recipient, the qualified professional must ensure and document
40.6that the personal care assistant is:
40.7(1) capable of providing the required personal care assistance services;
40.8(2) knowledgeable about the plan of personal care assistance services before services
40.9are performed; and
40.10(3) able to identify conditions that should be immediately brought to the attention of
40.11the qualified professional.
40.12(c) The qualified professional shall evaluate the personal care assistant within the
40.13first 14 days of starting to provide services for a recipient. The qualified professional shall
40.14evaluate the personal care assistance services for a recipient through direct observation of
40.15a personal care assistant's work:
40.16(1) at least every 90 days thereafter for the first year of services; and
40.17(2) every 120 days after the first year of service, or whenever needed for response to
40.18a recipient's request for increased supervision of the personal care assistance staff.
40.19(d) Communication with the recipient is a part of the evaluation process of the
40.20personal care assistance staff.
40.21(e) At each supervisory visit, the qualified professional shall evaluate personal care
40.22assistance services including the following information:
40.23(1) satisfaction level of the recipient with personal care assistance services;
40.24(2) review of the month-to-month plan for use of personal care assistance services;
40.25(3) review of documentation of personal care assistance services provided;
40.26(4) whether the personal care assistance services are meeting the goals of the service
40.27as stated in the personal care assistance care plan and service plan;
40.28(5) a written record of the results of the evaluation and actions taken to correct any
40.29deficiencies in the work of a personal care assistant; and
40.30(6) revision of the personal care assistance care plan as necessary in consultation
40.31with the recipient or responsible party, to meet the needs of the recipient.
40.32(f) The qualified professional shall complete the required documentation in the
40.33agency recipient and employee files and the recipient's home, including the following
40.34documentation:
40.35(1) the personal care assistance care plan based on the service plan and individualized
40.36needs of the recipient;
41.1(2) a month-to-month plan for use of personal care assistance services;
41.2(3) changes in need of the recipient requiring a change to the level of service and the
41.3personal care assistance care plan;
41.4(4) evaluation results of supervision visits and identified issues with personal care
41.5assistance staff with actions taken;
41.6(5) all communication with the recipient and personal care assistance staff; and
41.7(6) hands-on training or individualized training for the care of the recipient.
41.8(g) The documentation in paragraph (f) must be completed on agency forms.
41.9(h) The services that are not eligible for payment as qualified professional services
41.10include:
41.11(1) direct professional nursing tasks that could be assessed and authorized as skilled
41.12nursing tasks;
41.13(2) supervision of personal care assistance completed by telephone;
41.14(3) agency administrative activities;
41.15(4) training other than the individualized training required to provide care for a
41.16recipient; and
41.17(5) any other activity that is not described in this section.
41.18    Subd. 15. Flexible use. (a) "Flexible use" means the scheduled use of authorized
41.19hours of personal care assistance services, which vary within a service authorization
41.20period covering no more than six months, in order to more effectively meet the needs and
41.21schedule of the recipient. Each 12-month service agreement is divided into two six-month
41.22authorization date spans. No more than 75 percent of the total authorized units for a
41.2312-month service agreement may be used in a six-month date span.
41.24(b) Authorization of flexible use occurs during the authorization process under
41.25section 256B.0652. The flexible use of authorized hours does not increase the total
41.26amount of authorized hours available to a recipient. The commissioner shall not authorize
41.27additional personal care assistance services to supplement a service authorization that
41.28is exhausted before the end date under a flexible service use plan, unless the assessor
41.29determines a change in condition and a need for increased services is established.
41.30Authorized hours not used within the six-month period must not be carried over to another
41.31time period.
41.32(c) A recipient who has terminated personal care assistance services before the end
41.33of the 12-month authorization period must not receive additional hours upon reapplying
41.34during the same 12-month authorization period, except if a change in condition is
41.35documented. Services must be prorated for the remainder of the 12-month authorization
41.36period based on the first six-month assessment.
42.1(d) The recipient, responsible party, and qualified professional must develop a
42.2written month-to-month plan of the projected use of personal care assistance services that
42.3is part of the personal care assistance care plan and ensures:
42.4(1) that the health and safety needs of the recipient are met throughout both date
42.5spans of the authorization period; and
42.6(2) that the total authorized amount of personal care assistance services for each date
42.7span must not be used before the end of each date span in the authorization period.
42.8(e) The personal care assistance provider agency shall monitor the use of personal
42.9care assistance services to ensure health and safety needs of the recipient are met
42.10throughout both date spans of the authorization period. The commissioner or the
42.11commissioner's designee shall provide written notice to the provider and the recipient or
42.12responsible party when a recipient is at risk of exceeding the personal care assistance
42.13services prior to the end of the six-month period.
42.14(f) Misuse and abuse of the flexible use of personal care assistance services resulting
42.15in the overuse of units in a manner where the recipient will not have enough units to meet
42.16their needs for assistance and ensure health and safety for the entire six-month date span
42.17may lead to an action by the commissioner. The commissioner may take action including,
42.18but not limited to: (1) restricting recipients to service authorizations of no more than one
42.19month in duration; (2) requiring the recipient to have a responsible party; and (3) requiring
42.20a qualified professional to monitor and report services on a monthly basis.
42.21    Subd. 16. Shared services. (a) Medical assistance payments for shared personal
42.22care assistance services are limited according to this subdivision.
42.23(b) Shared service is the provision of personal care assistance services by a personal
42.24care assistant to two or three recipients, eligible for medical assistance, who voluntarily
42.25enter into an agreement to receive services at the same time and in the same setting.
42.26(c) For the purposes of this subdivision, "setting" means:
42.27(1) the home residence or family foster care home of one or more of the individual
42.28recipients; or
42.29(2) a child care program licensed under chapter 245A or operated by a local school
42.30district or private school.
42.31(d) Shared personal care assistance services follow the same criteria for covered
42.32services as subdivision 2.
42.33(e) Noncovered shared personal care assistance services include the following:
42.34(1) services for more than three recipients by one personal care assistant at one time;
42.35(2) staff requirements for child care programs under chapter 245C;
42.36(3) caring for multiple recipients in more than one setting;
43.1(4) additional units of personal care assistance based on the selection of the option;
43.2and
43.3(5) use of more than one personal care assistance provider agency for the shared
43.4care services.
43.5(f) The option of shared personal care assistance is elected by the recipient or the
43.6responsible party with the assistance of the assessor. The option must be determined
43.7appropriate based on the ages of the recipients, compatibility, and coordination of their
43.8assessed care needs. The recipient or the responsible party, in conjunction with the
43.9qualified professional, shall arrange the setting and grouping of shared services based
43.10on the individual needs and preferences of the recipients. The personal care assistance
43.11provider agency shall offer the recipient or the responsible party the option of shared or
43.12one-on-one personal care assistance services or a combination of both. The recipient or
43.13the responsible party may withdraw from participating in a shared services arrangement at
43.14any time.
43.15(g) Authorization for the shared service option must be determined by the
43.16commissioner based on the criteria that the shared service is appropriate to meet all of the
43.17recipients' needs and their health and safety is maintained. The authorization of shared
43.18services is part of the overall authorization of personal care assistance services. Nothing
43.19in this subdivision must be construed to reduce the total number of hours authorized for
43.20an individual recipient.
43.21(h) A personal care assistant providing shared personal care assistance services must:
43.22(1) receive training specific for each recipient served; and
43.23(2) follow all required documentation requirements for time and services provided.
43.24(i) A qualified professional shall:
43.25(1) evaluate the ability of the personal care assistant to provide services for all of
43.26the recipients in a shared setting;
43.27(2) visit the shared setting as services are being provided at least once every six
43.28months or whenever needed for response to a recipient's request for increased supervision
43.29of the personal care assistance staff;
43.30(3) provide ongoing monitoring and evaluation of the effectiveness and
43.31appropriateness of the shared services;
43.32(4) develop a contingency plan with each of the recipients which accounts for
43.33absence of the recipient in a share services setting due to illness or other circumstances;
43.34(5) obtain permission from each of the recipients who are sharing a personal care
43.35assistant for number of shared hours for services provided inside and outside the home
43.36residence; and
44.1(6) document the training completed by the personal care assistants specific to the
44.2shared setting and recipients sharing services.
44.3    Subd. 17. Shared services; rates. The commissioner shall establish a rate system
44.4for shared personal care assistance services. For two persons sharing services, the rate
44.5paid to a provider must not exceed one and one-half times the rate paid for serving a single
44.6individual, and for three persons sharing services, the rate paid to a provider must not
44.7exceed twice the rate paid for serving a single individual. These rates apply only when all
44.8of the criteria for the shared care personal care assistance service have been met.
44.9    Subd. 18. Personal care assistance choice option; generally. (a) The
44.10commissioner may allow a recipient of personal care assistance services to use a fiscal
44.11intermediary to assist the recipient in paying and account for medically necessary covered
44.12personal care assistance services. Unless otherwise provided in this section, all other
44.13statutory and regulatory provisions relating to personal care assistance services apply to a
44.14recipient using the personal care assistance choice option.
44.15(b) Personal care assistance choice is an option of the personal care assistance
44.16program that allows the recipient who receives personal care assistance services to be
44.17responsible for the hiring, training, and termination of personal care assistants. This
44.18program offers greater control and choice for the recipient in deciding who provides
44.19the personal care assistance service and when the service is scheduled. The recipient or
44.20the recipient's responsible party must choose a personal care assistance choice provider
44.21agency as a fiscal intermediary. This personal care assistance choice provider agency
44.22manages payroll, invoices the state, is responsible for all payroll related taxes and
44.23insurance, and is responsible for providing the consumer training and support in managing
44.24the recipient's personal care assistance services.
44.25    Subd. 19. Personal care assistance choice option; qualifications; duties. (a)
44.26Under personal care assistance choice, the recipient or responsible party shall:
44.27(1) recruit, hire, and terminate personal care assistants and a qualified professional;
44.28(2) develop a personal care assistance care plan based on the assessed needs
44.29and addressing the health and safety of the recipient with the assistance of a qualified
44.30professional as needed;
44.31(3) orient and train the personal care assistant with assistance as needed from the
44.32qualified professional;
44.33(4) supervise and evaluate the personal care assistant with the qualified professional;
44.34(5) monitor and verify in writing and report to the personal care assistance choice
44.35agency the number of hours worked by the personal care assistant and the qualified
44.36professional;
45.1(6) engage in an annual face-to-face reassessment to determine continuing eligibility
45.2and service authorization; and
45.3(7) use the same personal care assistance choice provider agency if shared personal
45.4assistance care is being used.
45.5(b) The personal care assistance choice provider agency shall:
45.6(1) meet all personal care assistance provider agency standards;
45.7(2) enter into a written agreement with the recipient, responsible party, and personal
45.8care assistants;
45.9(3) not be related as a parent, child, sibling, or spouse to the recipient, qualified
45.10professional, or the personal care assistant; and
45.11(4) ensure arm's-length transactions without undue influence or coercion with the
45.12recipient and personal care assistant.
45.13(c) The duties of the personal care assistance choice provider agency are to:
45.14(1) be the employer of the personal care assistant and the qualified professional for
45.15employment law and related regulations including but not limited to purchasing and
45.16maintaining workers' compensation, unemployment insurance, surety and fidelity bonds,
45.17and liability insurance, and submit any or all necessary documentation including, but not
45.18limited to, workers' compensation and unemployment insurance;
45.19(2) bill the medical assistance program for personal care assistance services and
45.20qualified professional services;
45.21(3) request and complete background studies that comply with the requirements for
45.22personal care assistants and qualified professionals;
45.23(4) pay the personal care assistant and qualified professional based on actual hours
45.24of services provided;
45.25(5) withhold and pay all applicable federal and state taxes;
45.26(6) verify and keep records of hours worked by the personal care assistant and
45.27qualified professional;
45.28(7) make the arrangements and pay taxes and other benefits, if any; and comply with
45.29any legal requirements for a Minnesota employer;
45.30(8) enroll in the medical assistance program as a personal care assistance choice
45.31agency; and
45.32(9) enter into a written agreement as specified in subdivision 20 before services
45.33are provided.
45.34    Subd. 20. Personal care assistance choice option; administration. (a) Before
45.35services commence under the personal care assistance choice option, and annually
45.36thereafter, the personal care assistance choice provider agency, recipient, or responsible
46.1party, each personal care assistant, and the qualified professional shall enter into a written
46.2agreement. The agreement must include at a minimum:
46.3(1) duties of the recipient, qualified professional, personal care assistant, and
46.4personal care assistance choice provider agency;
46.5(2) salary and benefits for the personal care assistant and the qualified professional;
46.6(3) administrative fee of the personal care assistance choice provider agency and
46.7services paid for with that fee, including background study fees;
46.8(4) grievance procedures to respond to complaints;
46.9(5) procedures for hiring and terminating the personal care assistant; and
46.10(6) documentation requirements including, but not limited to, time sheets, activity
46.11records, and the personal care assistance care plan.
46.12(b) Except for the administrative fee of the personal care assistance choice provider
46.13agency as reported on the written agreement, the remainder of the rates paid to the
46.14personal care assistance choice provider agency must be used to pay for the salary and
46.15benefits for the personal care assistant or the qualified professional. The personal care
46.16assistance choice provider agency must provide a minimum of 70 percent of the revenue
46.17generated by the medical assistance rate for personal care assistance for employee
46.18personal care assistant wages and benefits.
46.19(c) The commissioner shall deny, revoke, or suspend the authorization to use the
46.20personal care assistance choice option if:
46.21(1) it has been determined by the qualified professional or public health nurse that
46.22the use of this option jeopardizes the recipient's health and safety;
46.23(2) the parties have failed to comply with the written agreement specified in
46.24subdivision 20;
46.25(3) the use of the option has led to abusive or fraudulent billing for personal care
46.26assistance services; or
46.27(4) the department terminates the personal care assistance choice option.
46.28(d) The recipient or responsible party may appeal the commissioner's decision in
46.29paragraph (c) according to section 256.045. The denial, revocation, or suspension to
46.30use the personal care assistance choice option must not affect the recipient's authorized
46.31level of personal care assistance services.
46.32    Subd. 21. Requirements for initial enrollment of personal care assistance
46.33provider agencies. (a) All personal care assistance provider agencies must provide, at the
46.34time of enrollment as a personal care assistance provider agency in a format determined
46.35by the commissioner, information and documentation that includes, but is not limited to,
46.36the following:
47.1(1) the personal care assistance provider agency's current contact information
47.2including address, telephone number, and e-mail address;
47.3(2) proof of surety bond coverage in the amount of $50,000 or ten percent of the
47.4provider's payments from Medicaid in the previous year, whichever is less;
47.5(3) proof of fidelity bond coverage in the amount of $20,000;
47.6(4) proof of workers' compensation insurance coverage;
47.7(5) a description of the personal care assistance provider agency's organization
47.8identifying the names of all owners, managerial officials, staff, board of directors, and the
47.9affiliations of the directors, owners, or staff to other service providers;
47.10(6) a copy of the personal care assistance provider agency's written policies and
47.11procedures including: hiring of employees; training requirements; service delivery;
47.12and employee and consumer safety including process for notification and resolution
47.13of consumer grievances, identification and prevention of communicable diseases, and
47.14employee misconduct;
47.15(7) copies of all other forms the personal care assistance provider agency uses in
47.16the course of daily business including, but not limited to:
47.17(i) a copy of the personal care assistance provider agency's time sheet if the time
47.18sheet varies from the standard time sheet for personal care assistance services approved
47.19by the commissioner, and a letter requesting approval of the personal care assistance
47.20provider agency's nonstandard time sheet;
47.21(ii) the personal care assistance provider agency's template for the personal care
47.22assistance care plan; and
47.23(iii) the personal care assistance provider agency's template and the written
47.24agreement in subdivision 20 for recipients using the personal care assistance choice
47.25option, if applicable;
47.26(8) a list of all trainings and classes that the personal care assistance provider agency
47.27requires of its staff providing personal care assistance services;
47.28(9) documentation that the personal care assistance provider agency and staff have
47.29successfully completed all the training required by this section;
47.30(10) disclosure of ownership, leasing, or management of all residential properties
47.31that is used or could be used for providing home care services;
47.32(11) documentation of the agency's marketing practices; and
47.33(12) documentation that the agency will provide 75 percent for the personal care
47.34assistance choice provider agency and 65 percent for regular personal care assistance
47.35agency, or revenue generated from the medical assistance rate paid for personal care
47.36assistance services for employee personal care assistant wages and benefits.
48.1(b) Personal care assistance provider agencies shall provide the information specified
48.2in paragraph (a) to the commissioner at the time the personal care assistance provider
48.3agency enrolls as a vendor or upon request from the commissioner. The commissioner
48.4shall collect the information specified in paragraph (a) from all personal care assistance
48.5providers beginning upon enactment of this section.
48.6(c) All personal care assistance provider agencies shall complete mandatory training
48.7as determined by the commissioner before enrollment as a provider. Personal care
48.8assistance provider agencies are required to send all owners employed by the agency
48.9and all other managerial officials to the initial and subsequent trainings. Personal care
48.10assistance provider agency billing staff shall complete training about personal care
48.11assistance program financial management. This training is effective upon enactment of
48.12this section. Any personal care assistance provider agency enrolled before that date shall,
48.13if it has not already, complete the provider training within 18 months of the effective
48.14date of this section. Any new owners, new qualified professionals, and new managerial
48.15officials are required to complete mandatory training as a requisite of hiring.
48.16    Subd. 22. Annual review for personal care providers. (a) All personal care
48.17assistance provider agencies shall resubmit, on an annual basis, the information specified
48.18in subdivision 21, in a format determined by the commissioner, and provide a copy of the
48.19personal care assistance provider agency's most current version of its grievance policies
48.20and procedures along with a written record of grievances and resolutions of the grievances
48.21that the personal care assistance provider agency has received in the previous year and any
48.22other information requested by the commissioner.
48.23(b) The commissioner shall send annual review notification to personal care
48.24assistance provider agencies 30 days prior to renewal. The notification must:
48.25(1) list the materials and information the personal care assistance provider agency is
48.26required to submit;
48.27(2) provide instructions on submitting information to the commissioner; and
48.28(3) provide a due date by which the commissioner must receive the requested
48.29information.
48.30Personal care assistance provider agencies shall submit required documentation for
48.31annual review within 30 days of notification from the commissioner. If no documentation
48.32is submitted, the personal care assistance provider agency enrollment number must be
48.33terminated or suspended.
48.34(c) Personal care assistance provider agencies also currently licensed under
48.35Minnesota Rules, part 4668.0012, as a class A provider or currently certified for
48.36participation in Medicare as a home health agency under Code of Federal Regulations,
49.1title 42, part 484, are deemed in compliance with the personal care assistance requirements
49.2for enrollment, annual review process, and documentation.
49.3    Subd. 23. Enrollment requirements following termination. (a) A terminated
49.4personal care assistance provider agency, including all named individuals on the current
49.5enrollment disclosure form and known or discovered affiliates of the personal care
49.6assistance provider agency, is not eligible to enroll as a personal care assistance provider
49.7agency for two years following the termination.
49.8(b) After the two-year period in paragraph (a), if the provider seeks to re-enroll
49.9as a personal care assistance provider agency, the personal care assistance provider
49.10agency must be placed on a one-year probation period, beginning after completion of
49.11the following:
49.12(1) the department's provider trainings under this section; and
49.13(2) initial enrollment requirements under subdivision 21.
49.14(c) During the probationary period the commissioner shall complete site visits and
49.15request submission of documentation to review compliance with program policies.
49.16    Subd. 24. Personal care assistance provider agency; general duties. A personal
49.17care assistance provider agency shall:
49.18(1) enroll as a Medicaid provider meeting all provider standards, including
49.19completion of the required provider training;
49.20(2) comply with general medical assistance coverage requirements;
49.21(3) demonstrate compliance with law and policies of the personal care assistance
49.22program to be determined by the commissioner;
49.23(4) comply with background study requirements;
49.24(5) verify and keep records of hours worked by the personal care assistant and
49.25qualified professional;
49.26(6) pay the personal care assistant and qualified professional based on actual hours
49.27of services provided, and a minimum of 65 percent of the medical assistance rate paid for
49.28personal care assistance and qualified professional services in wages and benefits to the
49.29personal care assistant and qualified professional;
49.30(7) withhold and pay all applicable federal and state taxes;
49.31(8) make the arrangements and pay unemployment insurance, taxes, workers'
49.32compensation, liability insurance, and other benefits, if any;
49.33(9) enter into a written agreement under subdivision 21 before services are provided;
49.34(10) report suspected neglect and abuse to the common entry point according to
49.35section 256B.0651;
50.1(11) provide the recipient with a copy of the home care bill of rights at start of
50.2service; and
50.3(12) market agency services only through printed information in brochures and on
50.4Web sites and not engage in any direct contact or marketing in person, by telephone, or
50.5other electronic means to potential recipients, guardians recipients, guardians, or family
50.6members.
50.7    Subd. 25. Personal care assistance provider agency; background studies.
50.8Personal care assistance provider agencies enrolled to provide personal care assistance
50.9services under the medical assistance program shall comply with the following:
50.10(1) owners who have a five percent interest or more and all managerial officials are
50.11subject to a background study as provided in chapter 245C. This applies to currently
50.12enrolled personal care assistance provider agencies and those agencies seeking enrollment
50.13as a personal care assistance provider agency. Managerial official has the same meaning
50.14as Code of Federal Regulations, title 42, section 455. An organization is barred from
50.15enrollment if:
50.16(i) the organization has not initiated background studies on owners and managerial
50.17officials; or
50.18(ii) the organization has initiated background studies on owners and managerial
50.19officials, but the commissioner has sent the organization a notice that an owner or
50.20managerial official of the organization has been disqualified under section 245C.14,
50.21and the owner or managerial official has not received a set aside of the disqualification
50.22under section 245C.22;
50.23(2) a background study must be initiated and completed for all qualified
50.24professionals; and
50.25(3) a background study must be initiated and completed for all personal care
50.26assistants.
50.27    Subd. 26. Personal care assistance provider agency; communicable disease
50.28prevention. A personal care assistance provider agency shall establish and implement
50.29policies and procedures for prevention, control, and investigation of infections and
50.30communicable diseases according to current nationally recognized infection control
50.31practices or guidelines established by the United States Centers for Disease Control and
50.32Prevention, as well as applicable regulations of other federal or state agencies.
50.33    Subd. 27. Personal care assistance provider agency; ventilator training. The
50.34personal care assistance provider agency is required to provide training for the personal
50.35care assistant responsible for working with a recipient who is ventilator dependent. All
50.36training must be administered by a respiratory therapist, nurse, or physician. Qualified
51.1professional supervision by a nurse must be completed and documented on file in the
51.2personal care assistant's employment record and the recipient's health record. If offering
51.3personal care services to a ventilator-dependent recipient, the personal care assistance
51.4provider agency shall demonstrate the ability to:
51.5(1) train the personal care assistant;
51.6(2) supervise the personal care assistant in ventilator operation and maintenance; and
51.7(3) supervise the recipient and responsible party in ventilator operation and
51.8maintenance.
51.9    Subd. 28. Personal care assistance provider agency; required documentation.
51.10Required documentation must be completed and kept in the personal care assistance
51.11provider agency file or the recipient's home residence. The required documentation
51.12consists of:
51.13(1) employee files, including:
51.14(i) applications for employment;
51.15(ii) background study requests and results;
51.16(iii) orientation records about the agency policies;
51.17(iv) trainings completed with demonstration of competence;
51.18(v) supervisory visits;
51.19(vi) evaluations of employment; and
51.20(vii) signature on fraud statement;
51.21(2) recipient files, including:
51.22(i) demographics;
51.23(ii) emergency contact information and emergency backup plan;
51.24(iii) personal care assistance service plan;
51.25(iv) personal care assistance care plan;
51.26(v) month-to-month service use plan;
51.27(vi) all communication records;
51.28(vii) start of service information, including the written agreement with recipient; and
51.29(viii) date the home care bill of rights was given to the recipient;
51.30(3) agency policy manual, including:
51.31(i) policies for employment and termination;
51.32(ii) grievance policies with resolution of consumer grievances;
51.33(iii) staff and consumer safety;
51.34(iv) staff misconduct; and
51.35(v) staff hiring, service delivery, staff and consumer safety, staff misconduct, and
51.36resolution of consumer grievances; and
52.1(4) time sheets for each personal care assistant along with completed activity sheets
52.2for each recipient served.
52.3    Subd. 29. Transitional assistance. Notwithstanding any contrary provision in
52.4this section, the commissioner, counties, and personal care assistance providers shall
52.5work together to provide transitional assistance for recipients and families to come into
52.6compliance with the new live-in responsible party requirements of this section, and ensure
52.7that personal care assistance services are not provided by the housing provider. The
52.8commissioner and counties shall provide this assistance until July 1, 2010.
52.9    Subd. 30. Notice of service changes to recipients. All recipients who will be
52.10affected by the changes in medical assistance home care services must be provided notice
52.11of the changes at least 30 days before the effective date of the change. The notice shall
52.12include how to get further information on the changes, how to get help to obtain other
52.13services, if eligible, and appeal rights.

52.14    Sec. 15. Minnesota Statutes 2008, section 256B.69, subdivision 5a, is amended to read:
52.15    Subd. 5a. Managed care contracts. (a) Managed care contracts under this section
52.16and sections 256L.12 and 256D.03, shall be entered into or renewed on a calendar year
52.17basis beginning January 1, 1996. Managed care contracts which were in effect on June
52.1830, 1995, and set to renew on July 1, 1995, shall be renewed for the period July 1, 1995
52.19through December 31, 1995 at the same terms that were in effect on June 30, 1995. The
52.20commissioner may issue separate contracts with requirements specific to services to
52.21medical assistance recipients age 65 and older.
52.22    (b) A prepaid health plan providing covered health services for eligible persons
52.23pursuant to chapters 256B, 256D, and 256L, is responsible for complying with the terms
52.24of its contract with the commissioner. Requirements applicable to managed care programs
52.25under chapters 256B, 256D, and 256L, established after the effective date of a contract
52.26with the commissioner take effect when the contract is next issued or renewed.
52.27    (c) Effective for services rendered on or after January 1, 2003, the commissioner
52.28shall withhold five percent of managed care plan payments under this section for the
52.29prepaid medical assistance and general assistance medical care programs pending
52.30completion of performance targets. Each performance target must be quantifiable,
52.31objective, measurable, and reasonably attainable, except in the case of a performance
52.32target based on a federal or state law or rule. Criteria for assessment of each performance
52.33target must be outlined in writing prior to the contract effective date. The managed
52.34care plan must demonstrate, to the commissioner's satisfaction, that the data submitted
52.35regarding attainment of the performance target is accurate. The commissioner shall
53.1periodically change the administrative measures used as performance targets in order
53.2to improve plan performance across a broader range of administrative services. The
53.3performance targets must include measurement of plan efforts to contain spending
53.4on health care services and administrative activities. The commissioner may adopt
53.5plan-specific performance targets that take into account factors affecting only one plan,
53.6including characteristics of the plan's enrollee population. The withheld funds must be
53.7returned no sooner than July of the following year if performance targets in the contract
53.8are achieved. The commissioner may exclude special demonstration projects under
53.9subdivision 23. A managed care plan or a county-based purchasing plan under section
53.10256B.692 may include as admitted assets under section 62D.044 any amount withheld
53.11under this paragraph that is reasonably expected to be returned.
53.12    (d)(1) Effective for services rendered on or after January 1, 2009, the commissioner
53.13shall withhold three percent of managed care plan payments under this section for the
53.14prepaid medical assistance and general assistance medical care programs. The withheld
53.15funds must be returned no sooner than July 1 and no later than July 31 of the following
53.16year. The commissioner may exclude special demonstration projects under subdivision 23.
53.17    (2) A managed care plan or a county-based purchasing plan under section 256B.692
53.18may include as admitted assets under section 62D.044 any amount withheld under
53.19this paragraph. The return of the withhold under this paragraph is not subject to the
53.20requirements of paragraph (c).
53.21(e) Effective for services provided on or after January 1, 2010, the commissioner
53.22shall require that managed care plans use the fee-for-service medical assistance assessment
53.23and authorization processes, forms, timelines, standards, documentation, and data
53.24reporting requirements, protocols, billing processes, and policies for all personal care
53.25assistance services under section 256B.0659.

53.26    Sec. 16. Minnesota Statutes 2008, section 626.556, subdivision 3c, is amended to read:
53.27    Subd. 3c. Local welfare agency, Department of Human Services or Department
53.28of Health responsible for assessing or investigating reports of maltreatment. (a)
53.29The county local welfare agency is the agency responsible for assessing or investigating
53.30allegations of maltreatment in child foster care, family child care, and legally unlicensed
53.31child care and in, juvenile correctional facilities licensed under section 241.021 located
53.32in the local welfare agency's county, and unlicensed personal care assistance provider
53.33organizations providing services and receiving reimbursements under chapter 256B.
54.1(b) The Department of Human Services is the agency responsible for assessing or
54.2investigating allegations of maltreatment in facilities licensed under chapters 245A and
54.3245B, except for child foster care and family child care.
54.4(c) The Department of Health is the agency responsible for assessing or investigating
54.5allegations of child maltreatment in facilities licensed under sections 144.50 to 144.58 and
54.6144A.46, and in unlicensed home health care.
54.7(d) The commissioners of human services, public safety, and education must
54.8jointly submit a written report by January 15, 2007, to the education policy and finance
54.9committees of the legislature recommending the most efficient and effective allocation
54.10of agency responsibility for assessing or investigating reports of maltreatment and must
54.11specifically address allegations of maltreatment that currently are not the responsibility
54.12of a designated agency.

54.13    Sec. 17. Minnesota Statutes 2008, section 626.556, is amended by adding a subdivision
54.14to read:
54.15    Subd. 16. Abuse prevention plan. Home health care agencies and personal care
54.16assistance services providers shall develop an individual abuse prevention plan for each
54.17child receiving services from them. The plan shall contain an individualized assessment of:
54.18(1) the child's susceptibility to abuse by other individuals, including other children;
54.19(2) the child's risk of abusing other children; and
54.20(3) statements of the specific measures to be taken to minimize the risk of abuse
54.21to that child and other children.
54.22For the purposes of this subdivision, the term "abuse" includes self-abuse.

54.23    Sec. 18. RECOMMENDATIONS FOR PERSONAL CARE ASSISTANCE
54.24SERVICES CHANGES AND CONSULTATION WITH STAKEHOLDERS.
54.25The commissioner shall consult with representatives of interested stakeholders
54.26beginning in July 2009 to examine and develop recommendations for the personal care
54.27assistance services program, including recommendations to streamline the home care
54.28ratings and assignment of units of service to eligible recipients. The recommendations
54.29shall include proposed changes, alternative services, and costs for those whose services
54.30will change, as well as personal care assistance program data for public reporting. The
54.31recommendations are to result in a reduction of spending growth by $....... in personal care
54.32assistance services beginning January 1, 2011. The recommendations shall be provided to
54.33the chairs and ranking minority members of the legislative committees having jurisdiction
54.34over health and human services by January 15, 2010.

55.1    Sec. 19. RESULTS OF CHANGES TO THE PERSONAL CARE ASSISTANCE
55.2PROGRAM.
55.3The commissioner of human services must provide data to the legislative committees
55.4with jurisdiction over health and human services policy and finance by January 1, 2010,
55.5on the training developed and delivered for all types of participants in the personal
55.6care assistance program, audit and financial integrity measures and results, information
55.7developed for consumers and responsible parties, and quality assurance measures and
55.8results.

55.9    Sec. 20. REVISOR'S INSTRUCTION.
55.10    Subdivision 1. Renumbering of Minnesota Statutes, section 256B.0652,
55.11authorization and review of home care services. (a) The revisor of statutes shall
55.12renumber each section of Minnesota Statutes listed in column A with the number in
55.13column B.

55.14	Column A	Column B
55.15	256B.0652, subdivision 3	256B.0652, subdivision 14
55.16	256B.0651, subdivision 6, paragraph (a)	256B.0652, subdivision 3
55.17	256B.0651, subdivision 6, paragraph (b)	256B.0652, subdivision 4
55.18	256B.0651, subdivision 6, paragraph (c)	256B.0652, subdivision 7
55.19	256B.0651, subdivision 7, paragraph (a)	256B.0652, subdivision 8
55.20	256B.0651, subdivision 7, paragraph (b)	256B.0652, subdivision 14
55.21	256B.0651, subdivision 8	256B.0652, subdivision 9
55.22	256B.0651, subdivision 9	256B.0652, subdivision 10
55.23	256B.0651, subdivision 11	256B.0652, subdivision 11
55.24	256B.0654, subdivision 2	256B.0652, subdivision 5
55.25	256B.0655, subdivision 4	256B.0652, subdivision 6

55.26(b) The revisor of statutes shall make necessary cross-reference changes in statutes
55.27and rules consistent with the renumbering in paragraph (a). The Department of Human
55.28Services shall assist the revisor with any cross-reference changes. The revisor may make
55.29changes necessary to correct the punctuation, grammar, or structure of the remaining text
55.30to conform with the intent of the renumbering in paragraph (a).
55.31    Subd. 2. Renumbering personal care assistance services. The revisor of statutes
55.32shall replace any reference to Minnesota Statutes, section 256B.0655 with section
55.33256B.0659, wherever it appears in statutes or rules. The revisor shall correct any cross
55.34reference changes that are necessary as a result of this section. The Department of Human
55.35Services shall assist the revisor in making these changes, and if necessary, shall draft a
55.36corrections bill with changes for introduction in the 2010 legislative session. The revisor
56.1may make changes to punctuation, grammar, or sentence structure to preserve the integrity
56.2of statutes and effectuate the intention of this section.

56.3    Sec. 21. REPEALER.
56.4Minnesota Statutes 2008, sections 256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 1f, 1g,
56.51h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11, 12, and 13; and 256B.071, subdivisions 1, 2, 3, and 4,
56.6are repealed."
56.7Delete the title and insert:
56.9relating to human services; making changes to the personal care assistance
56.10program; private duty nursing; home care services; requiring a report;amending
56.11Minnesota Statutes 2008, sections 144A.44, subdivision 2; 256B.0625,
56.12subdivisions 6a, 7, 8, 8a, 19a, 19c; 256B.0651; 256B.0652; 256B.0653;
56.13256B.0654; 256B.0655, subdivisions 1b, 4; 256B.69, subdivision 5a; 626.556,
56.14subdivision 3c, by adding a subdivision; proposing coding for new law in
56.15Minnesota Statutes, chapter 256B; repealing Minnesota Statutes 2008, sections
56.16256B.0655, subdivisions 1, 1a, 1c, 1d, 1e, 1f, 1g, 1h, 1i, 2, 3, 5, 6, 7, 8, 9, 10, 11,
56.1712, 13; 256B.071, subdivisions 1, 2, 3, 4."